Orthodontic benefits are separate from dental benefits. Even though you are covered by dental insurance, you may not have orthodontic coverage. A plan booklet is generally available to you from your employer which describes the details of your policy and should outline any orthodontic coverage that might be available to you and your family. Familarizing yourself with the details of your coverage may avoid misunderstanding later. Eligibility The requirements for eligibility vary by policy. Some policies require a waiting period for new employees, while others may require a specific number of hours to be worked per pay period to remain eligible. Orthodontic coverage in some cases is available only to dependent children under the age of 19. If you are unsure of elgibility requirements, you should refer to the plan booklet or contact the insurance administrator at your place of business. How Benefits are Calculated Orthodontic benefits are paid over the length of orthodontic treatment. There is no universal formula for calculating the amoung to be paid toward the initial appliance placement fee or subsequent monthly fee. As an example it is common for the orthodontic benefits to be paid at 25% toward initial appliance placement. the balance of the orthodontic benefit remaining is then broken into monthly payments until the orthodontic maximum has been met. The insurance company determines the monthly amount they allow to be paid the claim is received based on how your employer selected your group benefit. Please keep in mind most plans have a yearly deductible they will not cover, so there may be a small balance due at the end of treatment that is your responsibility. If orthodontic insurance is acquired in mid treatment, some insurance companies will pro-rate the benefits they will allow. Be sure to refer to your insurance booklet as some insurance companies will not pay any benefit if insurance is not in effect at the begininning of treatment. In some cases even though the insurance benefit is $1000, the insurance companies have limits to what they will allow to be paid out per year. (example $350-500 per year) Please make sure you refer to your plan booklet to get this information to avoid any misunderstandings later. Flexible Benefits Plan and Executive Management Plans Flexible Benefit Plans have become a very popular method of projecting "Before Tax" dollars to be spent during the next plan year. These types of plans commonly allow the insured to allocate a specified number of salary dollars toward certain expenses, usually medical, dental or child care expenses. Because these dollars are not subject to payroll taxes, they are a very attractive way of increasing the value of your "insurance dollars." In most cases, there are very specific rules regarding the start date of treatment and coverage. You must declare the amount to be spent for the year prior to the beginning of the plan year. The plan year of the policy may not be a calendar year. You may wish to confirm the dates of the plan year. You stand to receive the greatest benefit by planning how orthodontic treatment can fit into the rules of your Flexible Benefit Plan. Also, check with your plan administrator to ensure you have all the correct documentation to receive your reimbursement. Every plan is different depending on what your employer has selected for you. What if I Have Multiple Coverage? If the patient is covered by more than one orthodontic insurance policy, the carriers will determine which plan is considered the primary policy. Often, this determination is made by birthdates of the insured parties. This method of determination is not a universal formula, but is individual to each carrier. The secondary insurance will not declare or pay benefits until the primary carrier has indicated if treatment will be covered. The secondary insurance company requires written confirmation of what the primary insurance paid. There are some insurance companies that do not allow double coverage and will state "No Dual" coverage clause. In this case you will only recieve the primary insurance benefit. How Our Orthodontic Office Can Help Insurance benefits are coordinated between the insurance carrier and you the insured. We are happy to call the insurance company and verbally confirm your orthodontic benefits. Please keep in mind information collected is not a guarantee of coverage and a determination is made when the claim is received by the insurance company. We are happy to prepare insurance claims or provide other information required by your insurance company. If your coverage changes and/or is lost, you will be responsible for any outstanding balance on your contract.