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How to Choose a Dental Benefits Plan

There is no one-size-fits-all when it comes to choosing a Dental Benefits Plan.

Whether you are an employer considering dental benefits for your employees, an individual considering benefits for yourself, or a parent considering benefits for the whole family, there are a variety of options to consider.

Small Business Dental Insurance Learning Topics:

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Things to Look for in a Dental Insurance Plan

For Employers| Employer dental plans offer affordability and flexibility based on multiple factors. For example, small group options designed for groups with 2-99 enrolled employees provide long-term rate stability based on being part of a community-rated pool of thousands of members. For employers with 100 or more employees, employers can choose between self-insured and full-insured plans.

For Individuals and Families | Dental plan options are available for individual's alone, an individual plus one, and an individual plus two or more. Access to benefits offers similar coverage to employee plans, as well as flexible payment options, choice of dentist, exceptional customer service and competitive rates. Read Choosing the Right Dental Plan for You and Your Family to learn more.

Other factors to look for...

  • Mobility | It is a mobile world! Maximizing your health from wherever you are whenever you need is important. Having a Mobile App [] to search for a dentist in an emergency situation, prove benefit plan status, confirm coverage and check the status of a claim are just some of the good reasons that having access to this feature can come in quite handy!
  • Waiting Periods | Waiting periods refer to any difference between the date when benefits go into effect and the date when you secured the plan. Waiting periods can range from three to six months for major restorative and orthodontic corrective services, and there is typically no waiting period for routine dental exams, cleanings and preventive x-rays.
  • Copayments | Copayments refer to out-of-pocket expenses. This may include a fixed shared cost each time you visit the dentist. Typically, the higher the plan premium, the lower the co-payment.
  • Types of Coverage | There are three general categories to consider when evaluating types of dental benefit coverage and benefits:
    1. Diagnostic and Prevention Coverage, which refers to routine exams, cleanings, x-rays, sealants, fluoride treatments, space maintainers and oral cancer screenings.
    2. Basic Restorative Coverage that relates to fillings, extractions, periodontal maintenance, denture repair, crown lengthening and emergency palliative treatment.
    3. Major Restorative Coverage that deals with complex issues such as gum disease treatment, dentures, root canal therapy, crowns, onlays and dental implants.

    For a better understanding of the different terms used in dental care and their meaning, visit the Glossary of Dental Insurance Terms. There is also a Glossary of Dental Clinical and Administrative Terms to help you further understand what dentists and staff are talking to you about during an exam as well as regarding your records and the processing of claims. For additional resources about oral and systemic health, risk assessments, minimally invasive dentistry and innovative products and services, visit Oral Health Resources.

  • Deductibles | A deductible refers to an amount you pay versus the insurance provider pays. Deductibles can apply to each person who is covered on a plan, as well as a family in total. A deductible is usually worded something like, "one-time deductible per person/family" followed by the amount of the deductible, such as "$75/225." This essentially means that each person has a $75 deductible up to a total of $225 for the whole family each year.
  • Maximum Benefit | Stated in terms of Per Year and Per Lifetime, Maximum Benefits refer to a limit of the total benefits payable under a plan. On a per year basis, the annual benefit typically applies to each person covered and can range from $1,000 to $2,000. Lifetime Maximum Benefits typically come into play for orthodontic care and refer to a cost ceiling per individual as well as a possible cost-sharing.
  • Network Access & Terms | The Network refers to a group of service providers that collaborate with the insurance provider in the administration of benefits. The common industry term for these providers is PPO, which stands for Preferred-Provider Organization. Using a PPO versus a dentist who is not in the network, means cost savings for all involved - you pay less for services than if you went outside of the network and the dentist's office saves on administrative costs as benefits and payment processing practices are typically agreed to in advance.
  • One of the benefits when working with an established dental insurance industry expert like Northeast Delta Dental, is that they offer access to a national network of dentists that extends across the U.S. and Puerto Rico, and participating dentists agree to specific billing and collecting practices.

  • Reimbursement Levels | Reimbursement levels refer to the percentage share of benefits offered for different types of services and different types of plans. The reimbursement process refers to a payment made by a third party, typically the insurance provider, to the dentist or the patient for a portion of the service cost covered under the plan.
  • One of the benefits for seeking services through a PPO is that in most cases, qualifying payments due the dentist are handled directly between the dentist and insurance provider saving the patient the time and hassle of getting in the middle.

Did you know?

"...that Northeast Delta Dental is a not-for-profit organization? Passionate about people and oral health, Delta Dental covers more people - individually and through company plans - and offer access to the largest network of participating dentists than any other dental benefits or insurance coverage program."

Learn More:     Page 1 | 2 | 3 | 4                         • • •                           Go to Top of Page

Other Small Business Dental Plan Learning Topics:
Why Dental Insurance? | Dental Plan Cost/Benefit Equation | Choosing a Dental Plan | Oral Hygiene Tips

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Note: This information has been compiled by the Knowledge Institute for Small Business Development (KISBD) for educational purposes only in order to convey a general overview of the options and related services available to small businesses in the subject areas introduced. Content is provided on an "as is" basis and is not intended to be an exhaustive representation, nor does it provide advice or create a customer relationship between KISBD and its sponsors,, its affiliates and any other organization named herein, and any reader.

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