We admit dental insurance terminology can be confusing, and we want to help. Our Customer Service team provided us with a list of common dental terms that members often ask them to explain. Here they are, along with definitions in plain language.
Please take a few minutes to become familiar with these terms and concepts. It will help you better understand your policy—and therefore get the most from your plan benefits.
Waiting period
A waiting period is the amount of time you will need to be enrolled in the dental plan before you’re eligible to receive benefits for certain dental services. The insurer may waive the waiting period based on prior insurance coverage. (See creditable coverage below.)
Missing tooth clause
Many dental policies have a waiting period for services to replace missing natural teeth. These services usually include initial placement of full or partial dentures, fixed bridges, or implants.
For most PacificSource dental plans, this wait is 36 months. However, we waive the waiting period if the natural tooth has been lost or extracted while covered under your current dental plan. In addition, you may possibly receive credit toward this waiting period if you’ve had previous dental coverage. (See creditable coverage below.)
Please be sure to review your dental policy or contact our Dental Customer Service team for your specific plan benefits.
Creditable coverage
Creditable coverage means past dental insurance coverage that may give you credit toward a waiting period. For example, if the waiting period is normally 60 days, but you had 30 days of creditable coverage, you would only need to wait 30 days. For coverage to be creditable, it must meet certain criteria. For PacificSource’s criteria, please see your policy or contact our Dental Customer Service team.
Contracted fee
“Contracted fee” refers to the fee for each single procedure that a contracted dentist has agreed to accept as payment in full for covered services provided to a dental plan member.
Pretreatment estimate (also known as a predetermination)
A pretreatment estimate or predeterminiation is a written estimate of benefits available as of a specific date, which you can request from your dentist. Estimates are subject to policy limitations and member eligibility at the time you receive services.
Balance billing
Balance billing is when an out-of-network dentist bills you for the difference between the provider charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred (in-network) provider will not balance bill you for covered services.
We encourage PacificSource dental members who have access to Advantage Dental to see providers in this network (our preferred dental network). Advantage dentists have agreed to accept our contracted fees, and they won’t balance bill our dental members.
Learn more
See our Glossary at PacificSource.com/glossary/.
If you’re a PacificSource member with questions about your dental coverage, please call our Dental Customer Service team at (866) 373-7053 or email dental@pacificsource.com.
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