Being familiar with insurance terminology helps you better understand your dental benefits.
L
Least Expensive Alternative Treatment
See "Alternative treatment"
Lifetime maximum
Most dental plans that cover orthodontia place a lifetime maximum on benefits. Some dental plans also set maximums on TMJ treatment, implants, and cosmetic services. Once a covered member reaches their lifetime maximum, the dental plan will no longer pay benefits for additional services for that dental plan member for those treatments.
Limitations
Dental plans place reimbursement limits for certain services. For example, dental plans often limit services based on certain timeframes. For example, many dental plans limit dental exam and cleaning coverage to twice per year or crown replacement coverage to once every five or ten years. Other services are subject to age limitations, such as sealants, which may only be covered for children up to a certain age (for example, age 19) or at a specified frequency (for example, once every five years). There are many dental plan limitations, so review your dental plan summary carefully to avoid receiving services that may be denied by the dental plan sponsor and result in higher costs.
