A Basic Glossary
- Annual Maximum: The maximum amount your policy will pay per year for dental care at Thomas Family Dentistry. It is usually divided into costs per individual or per family if you are on a family plan.
- Co-payment: An amount the patient pays at the time of service before receiving care. This amount is a required payment by the patient prior to the insurance paying for any portion of care.
- Covered Services: A list of all treatments, services, and procedures that the insurance policy will cover under your contract.
- Deductible: The dollar amount that you must pay out of pocket each year before the insurance company will pay for any treatments or procedures.
- Diagnostic/Preventive Services: A category of treatments or procedures that most insurances will cover before the deductible payment is required. These services may include regular checkups, cleanings, x-rays, fluoride treatments and evaluations at our office.
- In-Network & Out-Of-Network: The "network" is a list of providers that are a part of your insurance company's group of doctors that have agreed to accept your insurance company's set fees for treatment and therefore usually requires you to have lower out of pocket cost. Any provider that is not in the network will require you to usually pay a higher co-payment.
- Lifetime Maximum: The maximum amount that your plan will allow to paid for a lifetime. An example may be a lifetime amount that will be paid for braces.
- Limitations/Exclusions: A list of procedures that your insurance will NOT cover.
- Member/Insured/Covered Person/Beneficiary/Enrollee: Someone who is eligible to receive benefits under the dental insurance plan.
- Provider: Dr. Thomas or other oral health specialist who provides treatment.
- Waiting Period: A specified amount of time that the patient must be enrolled with your plan before it will pay for certain procedures.
There are many different insurance options and it is very important for you to find out exactly what your insurance policy covers. If you have any questions, you are encouraged to review your plan with your company's qualified insurance specialist, which can be provided to you by the employee's HR department. Don't be afraid to ask your employer or your insurance company's representative questions about your policy so that you can understand your coverage and be confident that you know everything that your policy covers the next time that you come in for treatment at our office.