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Large Group Deductible Dental Plan Evidence of Coverage

Large Group Deductible Dental Plan Evidence of Coverage 2025

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The document is a comprehensive Evidence of Coverage (EOC) for the Large Group Deductible Dental Plan provided by Kaiser Foundation Health Plan of the Northwest to the City of Vancouver. It outlines the dental benefits, including coverage details, eligibility requirements, premium information, and procedures for obtaining services. Key features include a benefit maximum of $1,500, various dental services covered under different categories (preventive, basic restorative, oral surgery, etc.), and specific exclusions and limitations. The document also details enrollment processes, member rights regarding disputes and appeals, and termination conditions for membership.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the procedure code in a dental claim?

In addition to forming part of the patient record, aiding the billing process, and helping expedite payment, procedure codes can be used to analyze what diagnoses and treatments a dentist has made and to compare one dentist to others with similar practices.

What is the most common type of dental insurance?

Dental health maintenance organization (DHMO) and dental preferred provider organization (DPPO) are the two most common dental insurance plans.

Which procedure category is most commonly covered at 80% by dental insurance?

Most dental insurance plans follow the 100/80/50 payment structure: They pay 100% for preventive care, 80% for basic procedures, and 50% for major procedures.

What are the three classifications of dental services?

Dental services are usually categorized into three types: preventive (cleanings, exams), basic restorative (fillings, root canals), and major restorative (crowns, bridges, dentures).

What are the classification of dental procedures?

Class 1: Preventative and diagnostic care, such as x-rays and cleanings. Class 2: Basic restorative care, including fillings and root canals. Class 3: Major restorative care, including dentures, bridges, and crowns.

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