Dental insurance can be a complex topic to navigate, with various terms, limitations, and conditions. In this guide, we'll break down how dental insurance works, and explain crucial aspects such as rolling vs. calendar year coverage, scaling units, exam/polish restrictions, fluoride limitations, and overall maximum coverage.

How Dental Insurance Works

Dental insurance is offered by private companies such as Pacific Blue Cross, Sunlife, Manulife, Canada Life, Green-shield, and many others. Its primary purpose is to assist individuals and groups in managing the expenses associated with maintaining their oral health.

Calendar Year Coverage vs. Rolling Year

Dental insurance plans may use either a calendar year or a rolling year to determine your coverage period:

Calendar Year: In a calendar year plan, your benefits reset on January 1st, regardless of when your coverage began. For example, if you have an allowance of 2 polish treatments per year, you must utilize them within the calendar year, typically from January 1st to December 31st. If unused, they expire at the end of that year.

Rolling Year: With a rolling year, your benefits reset one year from the date of your latests dental claims. For instance, if your plan allows for 2 polish treatments and you had one completed on January 12, 2023, and another on September 27, 2023, you would become eligible for your next polish one year from the most recent claims, in this case, on January 12, 2024.

Scaling Units and Their Usage

Dental cleanings are typically quantified in scaling units, where each unit equals 15 minutes of treatment. What sets this apart is the flexibility of using these scaling units throughout the year.

For instance, your dental insurance plan might grant you 12 units of scaling per year.

A standard maintenance dental cleaning typically falls within the range of 2 to 5 scaling units. The beauty of this system lies in your ability to use all of these units in a single visit or distribute them across multiple appointments. This adaptability empowers you to efficiently manage your oral hygiene treatment, which is determined by you and your oral health provider.

To illustrate, suppose your plan provides 12 units of scaling, and your dental hygienist recommends a 3-month maintenance interval that requires 45 minutes (3 units) of scaling per appointment. In this scenario, your dental insurance would cover all 4 appointments for teeth cleaning.

Exam/Polish/Fluoride Limitations

Dental insurance plans often come with restrictions on exams, polish, and fluoride treatments. These limitations can either be based on months or a specific number of uses throughout the year. For instance, a plan might limit you to two exams and polish per year or exams and polish every 6/9/12 months.

Fluoride Limitations by Age

Fluoride treatments are important for maintaining healthy teeth, especially for children and elders. Many dental insurance plans have age-based limitations on fluoride coverage. They may not cover fluoride treatments for individuals above a certain age, typically in the adult years. Ensure you check your policy for specific age restrictions.

Overall Maximum Coverage

Another important factor in dental insurance is the overall maximum coverage. This represents the maximum dollar amount that your insurance will pay within a year, even if you haven't reached the frequency limitations for specific procedures. If you've exceeded this limit, you'll be responsible for covering the remaining costs.

Maximizing Your Dental Insurance Benefits

To make the most of your dental insurance, follow these tips:

1. Regular Check-ups: Schedule and attend regular check-ups and cleanings to prevent costly dental issues.

2. Understand Your Plan: Familiarize yourself with your policy's terms, including coverage period, scaling units, and limitations.

3. Utilize Fostering Smiles: Consider having your dental hygiene services completed at Fostering Smiles to save money and use your benefits. Fostering Smiles follows the BCDHA fee guide for dental hygiene services and does not charge a surplus.

Conclusion
By understanding the concepts of rolling versus calendar year coverage, scaling units, exam/polish restrictions, fluoride limitations, and overall maximum coverage, you can confidently navigate the world of dental insurance. However, it's crucial to remember that while dental insurance can provide valuable financial support, it may not always align perfectly with your pursuit of optimal oral health.

Your path to maximizing dental insurance benefits begins with a thorough review of your specific policy details. This ensures that you make informed decisions and capitalize on your coverage. Remember, dental insurance is a valuable tool, but it's equally important to collaborate with your oral health provider to tailor your care to your unique needs.

A friendly reminder, depending on your insurance provider, Fostering Smiles is able to direct bill, complete insurance checks and provide estimates for appointments. Email info@fosteringsmiles.ca to learn more.