You may know about annual maximums – the most your dental plan will pay toward care in a 12-month period. But you may not have heard about lifetime maximums – the amount your dental plan will pay for care over the course of a lifetime.
Treatments subject to a lifetime maximum
Lifetime maximums rarely limit services like cleanings, regular checkups, fillings, crowns, root canals or periodontal treatments. Usually, they only apply to specific services such as orthodontic treatments.
For example, many plans will cover a fixed percent of orthodontic treatment in a plan year, up to an orthodontic lifetime maximum:
Cost of orthodontic treatment (braces) is $6,000
Dental plan covers 50% of orthodontics up to the lifetime maximum.
Orthodontic lifetime maximum: $1,500
In this example, your dental plan would cover $1,500 and you would be responsible for the remaining cost. In most cases, Delta Dental of South Dakota will make an initial payment of $1,000, with a second payment (if the plan’s orthodontic lifetime maximum is higher) made 12 months later as treatment progresses.
Lifetime maximums may “reset”
Lifetime maximums can sometimes be for the lifetime of that benefits plan only. If you or your employer switch benefits companies, the lifetime maximum may reset, or it may carry over.
Also, lifetime maximums typically don’t follow child dependents when they “outgrow” dependent coverage. Children may have a lifetime maximum as dependents under their parents’ dental plan, but usually receive new lifetime maximums when they become primary plan members as adults.
How to check your lifetime maximum
Some plans have lifetime maximums and others don’t. Review your plan coverage to find out:
- Read your plan booklet, which you may have received when you enrolled in your dental plan. You can also request one from us or your benefits administrator.
- Log in to your account at www.deltadentalsd.com or on our free mobile app to see the most up-to-date information on your lifetime maximum and how much remains.
- Call us toll-free at 1-877-841-1478 during regular business hours. We’re happy to help you understand your benefits!