Annual Maximum
The total dollar amount a plan will pay for dental care for an individual member or family member (under a family plan) for a specified benefit period, typically a calendar year.
Balance Billing
Out-of-network providers may bill patients for the balances remaining on the charges associated
with services rendered, after the insurance reimbursement amount is paid. You are responsible
for the difference between out-of-network billed charges and Delta’s maximum allowable fee.
Coinsurance
Your share of the costs of a covered dental expense calculated as a percent based on the
contracted rate you pay for services after your deductible is met.
Copayment (Copay)
The fixed dollar amount you pay each time you receive certain types of dental services. Copays vary depending on the service you’re receiving.
Deductible
The dollar amount you must pay for covered dental services before your insurance plan
starts to pay. Copayments do not apply to the deductible.
Family
A family plan consists of an employee, a spouse, and at least one dependent child. In our Delta Dental plan, once the deductible is met for three members of a family, it is met for all other members of the same family.
Maximum Allowable Fee
An amount determined by the dental vendor to be the prevailing charge for the service. This amount is based on a national database, complexity of services, range of services and prevailing charge in the geographic area.
In-Network
Dental providers who are contracted with the dental vendor. UHealth's Division of Oral and Maxillofacial Surgery and General Dentistry are in-network with Cigna and Delta.
Lifetime Maximum
The maximum amount a plan will pay over the course of a patient’s lifetime. It may apply to an individual or a family and typically applies to specific treatments such as orthodontic treatment.
Out-of-Network
A dental provider who is not contracted with the dental vendor.
Premium
The amount you'll be deducted each pay period to remain in the dental plan.
Referral
A recommendation from a general dentist to a specialist for a patient to receive advanced care for a particular condition or treatment.
Usual, Customary and Reasonable
The usual charge made by a physician or other provider of services that does not exceed the
general level of charges made by other providers for the same care in the same geographic area.
