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Suppose that you have a lifetime maximum with Provider A at Employer A. You use your $1500 lifetime maximum for major work.

Then you get a new job. Then you want to do more major work. You get an insurance plan again with Provider A at Employer B. Your insurance details are not forwarded and you have a new Dentist.

Will your lifetime maximum be reset?

  • Are you specifically asking about two plans with the same insurance provider, or did you mean to ask about insurance details being passed from one provider to another? – chepner Sep 19 '20 at 14:38
  • It is, coincidentally, the same plan at the same provider. But, it is a new plan (new of the same level plan) with a new employer (it was not carried over, old plan with old employer was cancelled). – finance Sep 23 '20 at 22:44
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The only way the new dental insurance plan would know about how much of the lifetime maximum you have used would be if the other insurance plan transferred that data. There is no national database.

The only time I know that this data was transferred was because I was switching between different types of plans inside the same insurance company, or when my employer picked a different provider. We were told these dental and medical maximums were being communicated. This was pre-ACA. The ACA removed most maximum caps, but not those related to adult dental coverage.

Some companies/plans don't have a lifetime cap. So they would be unlikely to transfer any data they have to the next insurance company. When changing employers I have not been required to tell them who my previous insurance company was.

The only time I ran into an issue where the current dental insurance company need information about a previous expense was when a crown was being replaced. The new plan wouldn't cover it unless it had been at least 10 years. Their explanation was that if it was less than that it was being replaced as part of the same "event" but if it was older than 10 years it was a repair of the crown. It was older, so it was covered.

If you have a new employer but the same insurance company, then it is likely that the lifetime cap will still be tracked. The cap isn't tracked by the dentist, it is only tracked by insurance companies. The dentist will recommend procedures and then the office staff will help you determine the cost of those procedures in advance. But the office doesn't know if you have met your deductible or if you have reached a yearly or lifetime cap without checking with the insurance company.

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    It sounds like the insurance provider is the same in both cases though, so why would they need to transfer any data? – Kat Sep 19 '20 at 15:13
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    @Kat Insurance companies have tons of plans and companies often negotiate changes even into existing plans. We don't even know for sure that the new plan has the same lifetime maximum. – mkennedy Sep 20 '20 at 16:00
  • @mkennedy I'm not suggesting the plan is the same, I'm saying the provider is the same, so they will already have a record of how much OP has received in benefits from them. I'm not sure how the amount of the new cap is relevant. – Kat Sep 20 '20 at 22:28
  • FYI @mkennedy you are right they may have negotiated the plan differently at new employer. But FYI $1500 has been the same lifetime maximum for most plans for decades; sadly, dental insurance has decreased their lifetime maximum year over year when you consider inflation. In this particular case, both plans have a $1500 lifetime maximum. – finance Sep 23 '20 at 22:46
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Delta dental states that lifetime maximums will follow people even if they change plans. However, the term lifetime is a bit of a mix between your lifetime vs the lifetime of the plan. If you switched insurance providers, you would have a new plan and the lifetime maximum may reset. Ultimately this will come down to the insurance provider and what their policies are and what level of communication they have with other providers (as mhoran_psprep describes).

https://www.deltadentalins.com/individuals/guidance/maximums.html

A lifetime maximum is the most money a dental plan pays for dental care for an enrollee or a family (under a family plan) for the life of the enrollee or family or the life of the plan.*

*Typically, if you move to another Delta Dental plan, your lifetime maximum would still be in force. (In other words, if you already met the maximum, you would have no more benefit.) If you’re moving from another dental carrier to a Delta Dental plan, carrying over the lifetime maximum will depend on whether your previous carrier has provided that information to us. You can contact Customer Service to find out once your Delta Dental plan is in effect.

  • It';s still not clear if you cancel your old plan entirely, but then get a new plan. – finance Oct 20 '20 at 20:18
  • @finance - I interpret Delta's guidelines to state that if you're staying with the same carrier, then it seems highly likely they will enforce the lifetime maximum. Considering they state that they may get that information from other carriers (cancelling with carrier A and moving to Delta), it seems that cancelling a Delta plan and going to a new Delta plan would have that info follow you. Ultimately, you will need to consult with your specific carrier to determine their specific rules/guidelines. – BobbyScon Oct 20 '20 at 20:30

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