What do dental policies usually cover, e.g., preventative care, filling cavities, orthodontics, cosmetic dentistry?

Most dental plans cover all of these kinds of dentistry except for cosmetic surgery. Plans will mainly differ in the amount of coverage for each service and in how you will pay for what isn’t covered. Depending on the type of plan, an employee may have a co-payment, co-insurance or a specific dollar amount to pay for a given service.

Various dental services will cover most or all of these services and can be broken down into three general areas:

• Preventive care
• Basic care
• Major care

Preventive care:

Preventative care includes things like exams, cleanings, and x-rays. Since these are considered necessary steps toward preventing costly dental problems, they’re usually covered 100% by a dental plan or with a small co-payment per visit.

Basic care:

Basic care includes dental issues like extractions or fillings. Root canals may or may not be included at this level of coverage. The insured will have either a co-payment or a co-insurance. In some cases, as with a DHMO, it may be a specific dollar amount.

Major care:

Major care involves more extensive procedures, and as such, these services are covered to a lesser extent. There is often a separate lifetime maximum amount of coverage for these services, which include crowns, implants, dentures, and bridges.

Most plans will not cover cosmetic procedures as these are considered non-essential to the employee’s dental health. Cosmetic procedures include bleaching, veneers, and bonding. Payment for such services would be the responsibility of the employee in almost any dental plan.

Helpful links:

ADA – This link provides useful guidance in selecting a dental plan.

Delta Dental Insurance – This link explains the basics of dental coverage.

Federal Dental – This link provides a typical breakdown of coverage for different classes of services.