A deductible is the amount you must pay out-of-pocket before your dental insurance begins paying for covered services. Typical deductibles range from $25 to $100 annually.
Coinsurance is the percentage of costs you share with insurance after meeting your deductible. For example, 20% coinsurance means you pay 20% and insurance pays 80%.
A copay is a fixed dollar amount you pay for a specific service, common in DHMO plans. Example: $10 copay per cleaning regardless of the actual service cost.
Annual maximum is the most your dental plan will pay for covered services in one year. Once reached, you pay 100% of costs until the benefit year resets.
UCR (Usual, Customary, and Reasonable) refers to the fees insurers consider standard for dental procedures in your geographic area. Plans reimburse based on UCR rates.
A waiting period is the time between enrolling in a plan and when certain services become covered. Waiting periods prevent people from buying insurance only when needing work.
Preauthorization (predetermination) is getting advance approval from your insurance company for proposed treatment, confirming coverage and expected payment amounts.
In-network refers to dentists who have contracted with your insurance company to provide services at negotiated rates, resulting in lower out-of-pocket costs for you.
Coordination of benefits (COB) determines which insurance pays first when you have multiple dental plans, preventing overpayment while maximizing your coverage.
EOB (Explanation of Benefits) is a statement from your insurer showing what was billed, what they paid, adjustments, and your remaining responsibility after a dental visit.