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Dental Insurance Benefits Part 3

Posted by  on 09-10-2019

Dental Benefits FAQs

1. What will my dental plan administrator do with the information I submit?

Once your plan administrator has the necessary forms and any supplementary information requested, he or she will be able to determine your plan’s liability based upon the provisions set out in the contract.

You will be sent an explanation of how the benefit was calculated. All, some or none of your treatments may be covered or, for some services, coverage may be limited to an alternative, less expensive procedure. It is important to understand that necessary treatment and covered expenses are not the same things.

2. My reimbursement was limited or declined. Where do I turn for clarification?

First, read the explanation from your plan administrator carefully. In most cases, it will explain how the benefit was calculated and it will identify any limitations or exclusions that have been applied. Look for language such as “Under the terms of your dental plan…”, “Your plan limits coverage to…” and “These services are covered only when…”.

These types of statements indicate that there are limitations within your contract and they have been applied to your claim. As a result, some or all of the costs associated with your treatment will remain an out-of-pocket expense not reimbursable under your plan.

For more detailed information about the specific provisions of your plan, either consult your employee handbook, discuss the matter with your benefits department or speak directly to your plan administrator.

The Advisory Services Department of The Ontario Dental Association is also able to provide you with assistance and advice.

(Information provided by the Ontario Dental Association)

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