What is a Benefit Period?

A benefit period is a specific timeframe, such as 12 months, during which your dental insurance benefits, coverage and restrictions apply. This period determines how your dental benefits are administered and how your coverage is calculated.

A benefit period typically resets each cycle. For example, if it is 12 months, it will reset annually.

A 12-month benefit period is also referred to as a “plan year.”

Examples:

• Calendar Year Benefit Period: January 1 to December 31. Many plans follow this structure, meaning your deductible and annual maximum reset on January 1 each year.
• Policy Year Benefit Period: Begins on the date your insurance coverage starts and ends exactly one year later. For example, if your coverage starts on July 1, the benefit period would run from July 1 through June 30 of the following year.
• Rolling Year Benefit Period: Some plans use a rolling year benefit period, meaning your benefits reset one year after the date of your first claim or other key events.

FAQs

• How does the benefit period affect my dental insurance coverage? The benefit period determines when your deductible and annual maximum reset. Once the period ends, you start fresh with a new deductible to meet and a new annual maximum.
• What happens if I don’t use all my benefits during the benefit period? Any unused benefits typically do not roll over to the next period unless your plan offers a carryover benefit. Your annual maximum will reset when the new benefit period begins.  
• Can I change my benefit period? No, the benefit period is determined by your insurance plan and cannot be changed by individual policyholders. However, understanding your benefit period can help you plan your dental care to maximize your benefits.

Example of a Pre-Determination of Benefits

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More Dental Insurance Terms Explained

1. What is a premium?
2. What is a waiting period?
3. What is a network dentist?
4. What is a benefit period?
5. What are preventive/diagnostic, basic and major dental procedures?
6. What is a deductible?
7. What is a copay?
8. What is co-insurance?
9. What is an annual maximum?
10. What is a claim?
11. What is an explanation of benefits (EOB)?
12. What is a pre-determination of benefits?
13. What are out-of-pocket expenses?

Back to Dental Insurance Terms Explained: A Quick Guide

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