Ensure your employees understand their insurance policies and know how to make the most of their benefits with this handy infographic. Print it out and post it around the office, or send out in an email.
36 percent of Millennial respondents to a recent survey, were able to define these terms correctly, whereas 47 percent of Baby Boomer respondents answered correctly. Get ready for open enrollment by getting up to speed on the terminology in your dental plan today.
Premium
People generally know what a “premium” is because they have to pay it. But, when other terms come into play, people aren’t so sure they know what their policy entails. The premium is the dollar amount paid by the individual signed up for dental coverage each month. The dental coverage company, such as Delta Dental, will usually pay between 50 – 80 percent of the cost, which is determined by your specific dental plan. The remaining amount is paid by the individual signed up for dental coverage, also known as the member.
Deductible
A deductible is the total amount enrollees pay each year toward their treatment before benefits kick in. Under Delta Dental benefit plans, diagnostic and preventive services are often exempt from a deductible. Check your plan specifics to see what your plan’s deductible is.
When surveyed, 74 percent of people were confident they knew what a deductible was. But, only 50 percent correctly defined it.
Coinsurance
After meeting the deductible, coinsurance determines the percentage of costs you pay. If your benefits pay for 80 percent of the cost, the remaining 20 percent is the coinsurance obligation that you will have to pay. The amount of coinsurance varies depending on your plan’s coverage.
When surveyed, 47 percent of people were confident they knew what coinsurance is. But, only 22 percent correctly defined it.
Copay
A set dollar amount you are required to pay your dentist for a service. An enrollee usually has a copayment or coinsurance, but not both. Also known as “copayment.”
When surveyed, 83 percent of people were confident they knew what a copay was. But, only 52 percent correctly defined it.
Out-of-Pocket Maximum
An out-of-pocket maximum is the most amount of money you will pay. Treatment is provided by a Delta Dental participating dentist who has agreed to our pay structure. If their fee is higher than your plan’s approved fee, this is absorbed by the dental office, not the enrollee or the plan. Most carriers now limit billing a patient for the difference between what the dentist charges and the agreed-upon charge established, which is referred to as “balance-billing.”
When surveyed, 67 percent of people were confident they knew what an out-of-pocket maximum was. But only 42 percent correctly defined it.
Coordination of Benefits (COB)
If you’re covered by more than one insurance company a coordination of benefits, or COB, is mandated by law. If your dental plan allows for this, the insurance providers will divide costs between more than one dental plan. The secondary plan will cover a predetermined amount after the first plan pays their portion.
Explanation of Benefits (EOB)
This frequently misunderstood document you receive in the mail often says, “This is not a bill.” An explanation of benefits resembles a bill because it details the breakdown of what exactly you are financially responsible for paying. You shouldn’t ever pay any more or any less than what is stated on the EOB.
Claim
After you visit the dentist, the dentist will submit a claim form to your dental insurance carrier requesting payment for the service they performed. The dental claim outlines the services and procedures the dentist or his staff performed at your visit.
For more on understanding your dental plan, check out: