What is a Waiting Period for Dental Insurance?
In this article, Dr. Meserkhani answers questions such as:
- What is a waiting period?
- Are some dental benefits more likely to have a waiting period?
- Are waiting periods legal?
- What can I do if I need a dental procedure immediately but my insurance has an unexpired waiting period
Ignorance of a Waiting Period Can Result in Uncovered Dental Procedures
Many consumers don't understand insurance waiting periods until they try to schedule a major dental service. A waiting period is the length of time from the effective date of an insurance policy until the policy will cover a specific benefit. The effective date is the date on which the policy becomes active (normally sometime after the insurance application is submitted and the first premium is paid).
Typically a waiting period applies to one or more dental benefits, but not all (though in theory, it could apply to all). During a waiting period, the insurance company will not pay for any claims on benefits subject to a waiting period. A waiting period is an attempt to avoid scenarios where consumers wait to buy insurance until they need an expensive procedure. From the perspective of an insurance company, there would be severe fiscal problems if consumers waited until they needed service to buy the insurance and then discontinued coverage after they received it. As a result, waiting periods may require continuous coverage (i.e. ongoing premium payments) for an extended period such as 6-months, 12-months, or longer.
Do All Dental Plans Have Waiting Periods?
No. Waiting periods vary by plans. Some plans may have waiting periods for several covered benefits while other plans may have no waiting periods. To review a state-by-state list of plans without waiting periods, see the article "Dental Insurance No Waiting Periods."
Additionally, some forms of dental coverage, such as a Discount Dental Plan, are not normally associated with waiting periods.
Yes. While waiting periods are not standardized in the dental insurance industry, expensive dental procedures such as crowns, root canals, dentures, implants, or orthodontic work are more likely to have a waiting period than a less expensive procedure such as a filling or preventive care such as cleaning or x-ray. Preventive care, however, may have an annual limit of two cleanings that must be spaced at least 6-months apart.
What Happens if I Get a Dental Procedure During Its Waiting Period?
If you receive a dental service during its waiting period then your dental plan is not obligated to pay the claim. Consequently, you will be responsible for the total cost without the aid of insurance.
Yes, waiting periods are legal for dental plans.
How Can I Know if a Specific Benefit Has a Waiting Period?
When you enrolled in your dental insurance, you should have received documentation that describes what is covered by the insurance plan and under what conditions. This document is often called a Summary of Benefits and should explain the various benefits within the dental plan as well as waiting periods if any apply.
What Can I Do If I Need a Dental Procedure Immediately But My Insurance Has an Unexpired Waiting Period
A waiting period can be extremely frustrating when you need dental care. If you need a dental procedure that is restricted by an active waiting period, you can:
- Shop for another dental plan that does not have a waiting period and can be effective in time for your dental procedure
- Join a Discount Dental Program, which is not insurance but does offer reduced rates on dental care
- Investigate whether there is a dental school in your area that offers reduced-cost care
Are Dental Plans the Only Type of Insurance that Has Waiting Periods?
No. Dental insurance is not the only form of health benefit that may impose a waiting period before coverage becomes available for the benefit enrollee. Group health plans may impose waiting periods of no more than 90 days for health benefits. Auto insurance and other property/casualty insurance may have waiting periods.