Dental waiting periods, deductibles, and exclusions

A dental plan can list a service as covered yet pay nothing for it today. A waiting period, unmet deductible, exclusion, or frequency limit may be the reason. Read each rule separately before telling employees a procedure is covered.

Know the difference

• Waiting period: Time before a person becomes eligible for a benefit. The ADA defines the term.
• Deductible: An amount the member pays before some plan benefits begin.
• Exclusion: A service the plan does not cover under its terms.
• Frequency limit: A rule on how often a service is payable.

HealthCare.gov warns that some stand-alone dental plans have waiting periods. The ADA explains that annual maximums, frequency limits, and waiting periods can each lead to a $0 plan payment.

Ask for a real example

Use the treatment an employee is most likely to need, such as a filling or crown. Ask when it becomes payable, whether a deductible applies, what percentage the plan pays, and whether any annual maximum remains. Then ask for the rule in writing.

For the other major limit, see our annual maximum explainer.