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Human Resources

Weekly Wellness - Dental Insurance & Annual Maximums

August 18, 2017

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What is an Annual Maximum Benefit for my dental plan?

Two of the dental plans at Lewis & Clark College have an annual dollar maximum of $1,500. This is the maximum dollar amount the dental insurance will pay toward the cost of all dental care within the calendar year (January through December). The patient is responsible for paying all costs above the annual maximum.

 
What costs are applied to the annual dollar maximum?

All costs the insurance pays towards dental fees applies to your annual maximum. For example:

  • Preventative Cleaning: total cost $150

    • Patient responsibility: $0

    • Insurance responsibility: $150 (applied to the annual maximum)

  • Crown: total cost $800

    • Patient responsibility: $400 (not applied to the annual maximum)

    • Insurance responsibility: $400 (applied to the annual maximum)

 
How can I find out how much of the maximum dollar amount I have used?

One important communication you receive is your Explanation of Benefits (EOB) statement. This is a document sent to you after you receive dental treatment. An EOB is not a bill. The EOB explains what procedures were covered under your benefits plan, as well as any procedures that might not have been covered and why they were not covered.
An EOB will tell you:

  • Dental services performed (description of procedures)

  • Dentist fees

  • Insurance responsibility of dentist fees

  • Patient responsibility of dentist fees (such as deductibles, coinsurance and non-covered services)

  • Annual maximum portions used and remaining

  • Deductible portions used and remaining

 

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