What Do Dental Plans Cover?

Dental procedures generally are divided into three categories: preventive, basic, and major.

1. Preventive dental care typically includes two preventive exams each year, including fluoride treatment, cleaning, and an annual set of x-rays. Preventative dental care is usually 100% covered on your dental plan.

2. Basic procedures include cavity fillings, tooth extractions, root canals, and deep cleaning.

3. Major procedures include crown placements, bridges, and denture work. Insurance plans might exclude coverage for specialty procedures.

Specialty dental areas like orthodontics, periodontics, and prosthodontics might be a covered benefit, but only after a waiting period or with a rider to your policy.

Every dental plan has its own specific covered benefits, so you should refer to the plan booklet, policy, or fee schedule to learn details about covered procedures, services excluded from coverage, and exceptions.

Types of Dental Coverage in Utah

Individuals interested in obtaining dental coverage in Utah can choose among different insurance companies and different types of plans, including the following.

  • Co-Pay Plans

    A co-payment, or co-pay, is a fixed amount an insured person pays for covered health care services. In co-pay dental plans, you might or might not have a deductible. Preventive services often are paid in full. Any in-network basic or major covered procedures require a fixed payment according to the plan’s fee schedule.

  • PPO Co-Insurance Plans

    A co-insurance is a percentage an insured person pays for covered health care services. In PPO co-insurance plans, you will likely have an annual deductible to meet. Preventive services usually are paid in full. Basic procedures by contracted dentists typically require a 20 percent co-insurance, and major covered procedures require a 50 percent co-insurance.

  • Dental Insurance vs. Dental Discount Plans

    Both dental insurance and dental discount plans can be useful in reducing your total dental expenses. But the two differ significantly in what is covered and how much you pay for that coverage.
    Dental discount plans, unlike dental insurance, do not pay any dental expenses for you. Instead, you receive discounted prices that typically range from 10 to 60 percent from participating dentists. You usually will not have any deductibles, waiting periods, or annual maximums.

Still have questions?

If you have questions or would like an Altura Benefits team member to help you with a dental quote please feel free to call us today!