How Dental Insurance Works: Your Questions, Answered

If you're like most people, dental insurance can feel confusing. You might be wondering: "What does my plan actually cover?" "Will I have to pay anything out of pocket?" "What's the difference between assignment and non-assignment?" Let's walk through how dental insurance really works, so you can feel confident about your coverage.

What is Dental Insurance, Really?

Think of dental insurance as a partnership between you, your insurance company, and your dental office. Your insurance plan is designed to help cover the cost of preventive care (like cleanings and exams) and often provides partial coverage for treatments like fillings, crowns, and other procedures.

Most dental insurance plans work on an annual basis with:

• Annual maximum: The total amount your insurance will pay in a calendar year (often $1,000-$2,000)
• Deductible: The amount you pay before insurance kicks in (usually $50-$100 per year)
• Coverage percentages: Most plans cover 100% of preventive care, 80% of basic procedures, and 50% of major procedures

Assignment vs. Non-Assignment: What's the Difference?

This is probably one of the most confusing aspects of dental insurance. Let's break it down:

At Arora Dental, we offer both options. Most of our patients prefer assignment because it's simpler—you know exactly what you owe upfront, and we handle the rest.

Coordination of Benefits: When You Have Multiple Plans

If you have dental coverage through both your own plan and your spouse's or partner's plan, you might be thinking: "Can I use both?" The answer is yes—this is called coordination of benefits.

Here's how it typically works:

1. Primary plan: Your own insurance plan is usually considered primary and pays first
2. Secondary plan: Your spouse's or partner's plan can then cover some or all of the remaining balance
3. Combined coverage: Together, both plans can significantly reduce or even eliminate your out-of-pocket costs

Important note: Your combined benefits can't exceed 100% of the treatment cost. But when coordinated properly, you can maximize your coverage and minimize what you pay.

Our team can help coordinate your benefits and submit claims to both insurance companies, making the process as smooth as possible for you.

Private Insurance Plans: What You Need to Know

Most dental insurance in Canada comes through private insurance companies. These are typically employer-sponsored plans, but you can also purchase individual plans. Common providers include Sun Life, Manulife, Canada Life, Green Shield, Blue Cross, and Desjardins—and we accept them all.

Here's what to keep in mind about private insurance:

• Pre-authorization: For major procedures (like crowns or root canals), your insurance may require pre-authorization. We can help with this.
• Annual maximums: Most plans reset on January 1st. If you haven't used your benefits, they don't roll over—so use them or lose them!
• Frequency limits: Plans often limit how often you can get certain treatments (e.g., cleanings every 6-9 months)
• Waiting periods: New plans may have waiting periods before covering major procedures

The good news? We work with virtually all major insurance providers and can help you understand exactly what your plan covers before you start treatment.

What to Expect at Your Appointment

When you come in for your appointment, here's what happens with your insurance:

1. Before treatment: We'll verify your insurance coverage and get a pre-authorization if needed, so you know exactly what's covered before we start.
2. During your visit: We provide the care you need, whether it's a cleaning, filling, or more complex procedure.
3. After treatment: If you're using assignment, we submit the claim to your insurance company. You pay only your portion (co-pay, deductible, or non-covered amount) right away.
4. Insurance processing: Your insurance company processes the claim (usually within 1-2 weeks) and pays us directly for their portion.

The bottom line: We handle the insurance paperwork so you don't have to. Our goal is to make dental care as simple and stress-free as possible.

Common Questions About Dental Insurance