Common Dental Insurance Terms and Definitions

Annual maximum
Most insurance companies have an annual maximum dollar amount of coverage for each patient listed under the insurance policy.
Basic procedures
Common procedures including most diagnoses, routine dental X-ray films, preventive dental care, direct fillings, root canal treatment, treatment of periodontal disease, and most routine oral surgery such as tooth extraction.
Co-payment and fee schedule difference, or “out of pocket portions”
This is the part of the dental service fee not covered by a patient's insurance.
Coverage Annual Renewable
The date when your benefits are renewed. This may be a calendar year (from Jan.1 to Dec.31 of each year), or rolling 12 months starting from an initial effective date.
Deductible
The dollar amount the patient pays towards their total treatment fees before insurance coverage begins.
Dental implants
Implants involve both a surgical procedure (to place an implant inside the jaw or alveolar bone) and restorative or prosthesis procedures. The coverage for implant treatment varies greatly between different insurance policies and requires pre-authorization.
Dual coverage
When both spouses are covered by two insurances plans. Note that this may still not cover 100% of the dental fee.
Eligibility
The person(s) covered under the insurance policy.
Exclusion
Those dental procedures not covered by your benefits.
Fee schedule
The dental service fee set for every procedure. Fee schedules vary widely between dental insurance companies as well as different dental offices across Alberta.
Limitation on how often, or total allowance per year/rolling 12 months
The limit on the number of times a procedure can be done every year or 12 months.
Major procedures
Less common procedures including posts, inlays, onlays, crowns, bridges, and dentures. Most major procedures must be pre-authorized by a dentist to ensure it is needed.
Non-assignment
After undergoing a procedure, the patient must pay the dentist in full upfront. The insurance company will then send their payment directly to the patient.
Orthodontic treatment
This is listed as a separate benefit by dental insurance companies. Usually insurance benefits offer 50% coverage with a lifetime maximum (the maximum is not renewed). Coverage may also be age limited. Orthodontic treatment usually requires pre-authorization to determine a patient's eligibility.
Pre-authorization
A written treatment plan prepared by your dental office and submitted to your dental insurance company for pre-estimation of the coverage amount.
Procedure code
The five-digit standard dental service code in Canada for any given procedure.
   Office Hours
   Dr. Alvin Kwok
   Mon-Thurs 9-6, Fri/Sat off, Sunday by appointment only

 
   ASK Dental Clinic    Unit 200, 4400-14th Street NW 
   Calgary, AB T2K 1J5
   Phone:  403.210.0883    Email:  asknet@telus.net