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Orthodontics

Orthodontics covers the cost of correcting tooth alignment and jaw positioning using braces or aligners. In individual and group dental plans, orthodontic benefits are usually separate from preventive and restorative coverage. Most plans apply a lifetime maximum and a waiting period before orthodontic treatment is eligible.

Orthodontic reimbursement is typically 50 percent of eligible costs up to a set limit, such as $2,000 per person. The benefit may also have an age restriction, commonly limited to dependents under 19. Orthodontic coverage can significantly reduce the cost of braces or Invisalign for children and adults alike, depending on the plan tier.

Example:

If your orthodontic coverage reimburses 50 percent up to a $2,000 lifetime maximum, and treatment costs $4,000, your plan pays $2,000 and you pay the rest.

What to Watch For:

Confirm eligibility age and waiting period. Lifetime maximums do not reset, so plan timing carefully before starting treatment.

Related Terms

Optional Benefit / Rider / Add-On

An optional benefit, also called a rider or add-on, is an additional feature that can be purchased to enhance your existing health, dental, life, or disability insurance plan. Optional benefits allow you to customize coverage by adding protection that suits your personal needs, rather than relying only on the base plan design.

Dental Insurance

Dental insurance is a type of health coverage that helps pay for the cost of preventive, basic, and major dental services. It is designed to make oral care more affordable and to encourage regular checkups that prevent costly procedures later on. Dental insurance is offered through group employee benefits, individual plans, or conversion plans for people leaving workplace coverage.

Diagnostic

Diagnostic refers to tests, procedures, or evaluations performed by healthcare professionals to identify the cause, nature, or extent of a medical or dental condition. Diagnostic services are the foundation of effective treatment, helping doctors and dentists determine the most appropriate care plan. In health and dental insurance, diagnostic expenses are often covered as eligible services when they are medically necessary and performed by a licensed provider.

Accident

An accident is an unexpected, sudden, and external event that causes bodily injury, occurring independently of any illness or pre-existing condition. In the context of health and dental insurance, an accident typically refers to physical harm resulting from an unforeseen incident such as a fall, collision, or blow to the body. Accidents are distinct from sickness or degenerative conditions because they are caused by an identifiable event rather than a gradual process.

Dentist

A dentist is a licensed healthcare professional who diagnoses, treats, and helps prevent conditions affecting the teeth, gums, and mouth. Dentists play a key role in maintaining oral health through preventive care, restorative treatments, and patient education. Common services include cleanings, fillings, crowns, root canals, extractions, and oral examinations.

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