what does fidelis dental cover for adults

Natashya

3 min read

·

25-12-2024

1

0

Share

Meta Description: Unsure what Fidelis dental insurance covers for adults? This comprehensive guide breaks down Fidelis dental plans, outlining coverage for checkups, cleanings, fillings, orthodontics, and more. We'll also explore common exclusions and how to maximize your benefits. Get the details you need to understand your Fidelis dental coverage!

Understanding Your Fidelis Dental Plan

Fidelis Care offers several dental plans for adults, each with varying levels of coverage. The specifics of what's covered depend on the exact plan you have. To understand your coverage completely, always refer to your individual plan's summary of benefits and coverage (SBC). This document, provided by Fidelis, details your plan's specifics.

It's crucial to remember that Fidelis dental plans are typically not standalone plans. They're usually part of a larger health insurance package. This means your dental benefits may be integrated with other medical services.

Key Areas of Coverage: What to Expect

Most Fidelis adult dental plans cover a range of essential services. However, the extent of coverage—such as the percentage reimbursed and any annual maximums—will vary.

1. Preventative Care: This is usually the most comprehensive area of coverage. Expect coverage for:

• Routine Checkups: Regular checkups are essential for maintaining good oral health. These are usually covered at a high percentage.
• Dental Cleanings: Professional cleanings help remove plaque and tartar, preventing gum disease and cavities. These are also typically covered extensively.
• X-rays: Diagnostic x-rays are a key part of preventative care, often covered at least partially.

2. Basic Restorative Care: This category covers treatments for problems that have already developed:

• Fillings: For cavities and tooth decay, fillings are a common procedure covered by many plans. The extent of coverage may depend on the material used (e.g., amalgam vs. composite).
• Extractions: If a tooth needs to be removed, extraction may be covered. The specific coverage can vary depending on the reason for the extraction.
• Root Canals: This procedure saves a severely damaged tooth. Coverage often exists, but may be subject to limitations.

3. Major Restorative Care: These are more extensive and costly procedures:

• Crowns and Bridges: These restore damaged teeth or replace missing ones. Coverage for these is generally lower than preventative care.
• Dentures and Partials: Replacing missing teeth, coverage may be limited, particularly for full dentures.

4. Orthodontics: This is often a separate category with limited or no coverage in basic plans. More comprehensive plans may include some orthodontic coverage, but often require a separate waiting period. This coverage might be limited to children or young adults.

Common Exclusions: What's Usually Not Covered

While Fidelis plans aim to cover essential dental care, some treatments are usually excluded or only partially covered:

• Cosmetic Procedures: Procedures solely for aesthetic reasons (e.g., teeth whitening) are often not covered.
• Implants: These are typically not covered under most Fidelis plans.
• Orthodontics (in many plans): As mentioned above, orthodontic work is often a separate, limited benefit or requires a separate waiting period.

How to Maximize Your Fidelis Dental Benefits

To get the most from your Fidelis dental coverage:

• Understand your plan: Carefully review your SBC. Pay close attention to coverage percentages, annual maximums, and waiting periods.
• See a participating provider: Using in-network dentists helps keep costs lower and ensures smoother claims processing. Fidelis' website or member portal usually lists providers.
• Schedule regular checkups: Preventative care is often the most comprehensively covered area. Routine visits can help prevent more extensive and costly treatments later.
• Submit claims promptly: Follow Fidelis' instructions for submitting claims to ensure timely processing.

Finding More Information

For the most accurate and up-to-date information about your specific Fidelis dental plan's coverage, always check your plan's summary of benefits and coverage document. You can usually find this document online through your Fidelis member portal or by contacting Fidelis customer service directly.

This article provides general information. Consult your plan materials and a dental professional for personalized advice on your specific dental needs and coverage.