# Dental

A complete dental plan schema can be found in the Dental Plan Show endpoint ([API docs](https://docs.ideonapi.com/#dental-plans-dental-plans-get)). The latest available version, *v8*, must be specified in the request headers. Ideon's dental data is sourced directly from carriers and standardized into this data schema. Dental plans can be available across multiple years, defined uniquely by their `id`. 

This page is organized into sections to cover all data for dental plans, including their metadata and benefits. All sections are included on a single page to enable cmd+f searching based on schema keys or conventional terminology. Not all fields in the dental plan schema are included; those omitted are redundant or legacy fields. The navigation pane in the top-right of the page can be used to quickly jump between sections. 

## Plan Metadata

A plan's metadata includes all information that is not considered a cost share based benefit. Fields such as plan type, benefit summary documents, and more are included. Given the breadth of data included, format, and data type varies by metadata field. The below tables list all fields included in Ideon's dental plan dataset and summaries of how the data is presented.

### Plan Identifiers

The availability and structure of plan identifiers varies by carrier for dental plans. Most carriers have unique identifiers available as plan codes or numbered plans. These are included in the `identifiers` array and commonly referenced in the plan's `name` as well.

<table data-full-width="true"><thead><tr><th width="149.9918212890625">Metadata Field</th><th width="150.055419921875">API Schema Key</th><th width="100.34765625">Data Type</th><th width="200.1495361328125">Example</th><th>Notes</th></tr></thead><tbody><tr><td>Internal Ideon ID</td><td>id</td><td>string</td><td>"WQmui7Mi"</td><td>The unique ID for the plan, internal to Ideon's database.</td></tr><tr><td>Carrier-specific Identifiers</td><td>identifiers[type="issuer_internal_id"].value</td><td>string</td><td>"37783329"</td><td>The identifier(s) used by the carrier to reference the plan. One or more identifiers with the same or different <code>type</code> can be included for a single plan. Identifiers with a <code>type</code> of <em>plan_scraper_key</em> should be ignored. </td></tr></tbody></table>

### Carrier Information

<table data-full-width="true"><thead><tr><th width="149.981201171875">Metadata Field</th><th width="149.50140380859375">API Schema Key</th><th width="99.9853515625">Data Type</th><th width="199.6097412109375">Example</th><th>Notes</th></tr></thead><tbody><tr><td>Carrier Info - ID</td><td>carrier.id</td><td>string</td><td>"d31dc8f5-00bd-422d-bcb3-44caa4227b38"</td><td>Unique identifier for the carrier, consistent across Ideon's Quote and Select data.</td></tr><tr><td>Carrier Info - Name</td><td>carrier.name</td><td>string</td><td>"Humana"</td><td>The carrier's brand or marketing name.</td></tr><tr><td>Carrier Info - Logo URL</td><td>carrier.logo_url</td><td>string</td><td>"https://d1hm12jr612u3r.cloudfront.net/images/logos/353/thumb.png?1724342730"</td><td>Carrier logos are presented in thumb size by default. To access a higher resolution image, replace "thumb" in the URL with "medium".</td></tr><tr><td>Carrier Info - Issuer ID</td><td>carrier.issuer_id</td><td>string</td><td>"A0001"</td><td>The Ideon-generated issuer ID for the carrier. For Dental plans, there is a one to one relationship between a carrier and the issuer ID.</td></tr><tr><td>Carrier Disclaimers</td><td>carrier_disclaimers</td><td>string</td><td>"For all Principal plans, only one plan, per group, can be selected."</td><td>Disclaimers are open-text strings that pass through important information from the carrier. They are only used when the disclaimer is specifically requested to be included by the carrier providing the data. Disclaimers are typically between 50 - 500 characters. Rarely, they can exceed 1,000 characters in length.</td></tr></tbody></table>

### Additional Metadata

<table data-full-width="true"><thead><tr><th width="150.43927001953125">Metadata Field</th><th width="149.96307373046875">API Schema Key</th><th width="99.5167236328125">Data Type</th><th width="200.2027587890625">Example</th><th>Notes</th></tr></thead><tbody><tr><td>Plan Name</td><td>name</td><td>string</td><td>"Premier Blue Copay 50/50 $4500"</td><td>The name of the plan as detailed in carrier documentation.</td></tr><tr><td>Benefits Summary Document</td><td>benefits_summary_url</td><td>string</td><td>"https://d2ed110nmrd591.cloudfront.net/blobs/TMeP4mZdUucDne2K8FS8o7gt.pdf"</td><td>The benefit summary documents that ancillary carriers provide will be available via this link; document structure will vary by carrier.</td></tr><tr><td>Plan Type</td><td>plan_type</td><td>enum</td><td>"PPO"</td><td>Valid values are <em>EPO</em>, <em>HMO</em>, <em>PPO</em>, <em>POS</em>, <em>POS+, Indemnity,</em> or <em>N/A</em>.<br><br>The plan types <em>MAC PPO</em> and <em>UCR PPO</em> are used in rare scenarios, but are being phased out and not used for future plans.</td></tr><tr><td>Quoted via Carrier's API</td><td>quoted_via_carrier_api</td><td>boolean</td><td>true or false</td><td>Indicates whether or not the plan is quoted in real-time through an integration to the carrier's API (indicated by <em>true</em>). Plans with a <em>false</em> value in this field are quoted by Ideon's rating engine.</td></tr><tr><td>Copay Schedule</td><td>copay_schedule</td><td>boolean</td><td>true or false</td><td>Indicates whether or not the plan's benefit cost shares are defined by copays (<em>true</em>) or by coinsurances (<em>false</em>).</td></tr><tr><td>Out of Network Reimbursement Type</td><td>out_of_network_reimbursement_type</td><td>enum</td><td>"UCR"</td><td><p>Valid values are:</p><ul><li><em>UCR</em> – the plan reimburses based on what it considers a "usual and reasonable" fee for a procedure in a given geographic area. Charges above this threshold are the member's responsibility.</li><li><em>MAC</em> – the plan sets a fixed maximum it will pay for a given procedure, regardless of what the provider charges. Amounts above the cap are billed to the member.</li><li><em>null</em> – the out-of-network reimbursement methodology is not explicitly defined in the plan's benefit documentation.</li></ul></td></tr><tr><td>Usual Customary Reasonable (UCR) Percentile</td><td>usual_customary_reasonable_percentile</td><td>integer</td><td>90</td><td>Integer value between 0 and 100, indicating the reimbursement percentage of qualified out-of-network claims. Used when the <code>out_of_network_reimbursement_type</code> is <em>UCR</em>. </td></tr></tbody></table>

## Deductibles and Annual Maxes

Deductibles and Annual Maxes have a limited set of grammar used to define a plan's coverage. These are represented in the `in_network`, `out_of_network`, and `limit` keys. The valid grammar for deductibles and Annual Maxes is detailed in the table below.&#x20;

This grammar is consistent across the `adult_individual_deductible`, `child_individual_deductible`, `family_deductible`, `adult_individual_anual_max`, and `child_individual_annual_max` fields. The `child_individual_moop` is not used for the majority of current-year plans.

<table data-full-width="true"><thead><tr><th width="175.10015869140625">Grammar Format</th><th width="134.12744140625">Structure</th><th width="134.367919921875">Example</th><th>Notes</th></tr></thead><tbody><tr><td>Standard Deductible or Annual Max<br>(<code>in_network</code>, <code>out_of_network)</code></td><td>$X</td><td>$5,000</td><td>This value will rarely have <em>per year</em> or <em>per person</em> appended to the string when carriers specifically require it for compliance. </td></tr><tr><td>Unlimited Annual Max<br>(<code>in_network</code>, <code>out_of_network)</code></td><td>Unlimited</td><td>Unlimited</td><td>This is used to reflect carrier documentation that specifies the same "Unlimited" language for the Annual Max.</td></tr><tr><td>Not Applicable Deductible or Annual Max<br>(<code>in_network</code>, <code>out_of_network)</code></td><td>Not Applicable</td><td>Not Applicable</td><td>The <em>Not Applicable</em> string is used when the Deductible or Annual Max value is not included nor implied in carrier documentation.</td></tr><tr><td>Waived Deductibles<br>(<code>limit</code>)</td><td>waived for preventive care</td><td>waived for preventive care</td><td>This string is used for Deductible values that are waived for preventive care, but still apply for any services categorized as basic, major, or ortho.</td></tr></tbody></table>

## Coverage Tiers

The `coverage_tiers` object includes `preventive`*,* `basic`, and `major` fields that detail the cost shares for services of each tier. Each of these three coverage tiers includes `in_network`, `out_of_network`, and `limit` keys; `limit`'s are rarely used for coverage tiers. Cost share values in the `coverage_tiers` objects are represented as coinsurance amounts, in the format of *X%*; for example, *90%*. In the `coverage_tiers` objects, this amount refers to the amount the plan pays for services of that tier.&#x20;

It is important to note that this presentation of cost shares for the high-level coverage tiers (amount the plan pays) is the inverse of how plan benefit cost shares are presented; which show the cost to the plan enrollee. These representations are used for consistency across coverage tiers, plan benefits for copays and coinsurances, and with how carrier benefit documentation is typically presented.

## Plan Benefits

Plan benefits are presented as the cost share the plan enrollee is responsible for. Data for each benefit includes the cost shares for seeing In-Network and Out-of-Network providers as well as any limitations on usage. The fillings benefit below shows an example of how this might be presented.

```json
"restoration_fillings": {
    "in_network": "10%",
    "out_of_network": "20%",
    "limit": "1 treatment(s) per 1 tooth per 2 year(s)",
    "coverage_tier": "basic"
}
```

For grammar formats and notes, the most common use cases are included. This is not an exhaustive list of all cost share and limit formats; values not listed here are rarely used to handle edge case scenarios. Tiered in-network benefits, as described for Medical plans in the [Tiered Medical Benefits section](/quote-and-select/additional-information-and-workflows/benefit-grammar-guides/medical.md#tiered-plan-benefits), are very rarely used for Dental plans.

### Coverage Tier

Each benefit is categorized in it's respective coverage tier; the valid `coverage_tier` options are *preventive, basic, major, orthodontics,* and *null*. A *null* value indicates that the benefit is not covered by the plan.

The `coverage_tier` categorization for each benefit will be consistent with the higher-level `coverage_tiers` object. For example, let's say the `coverage_tiers.preventive.in_network` value is *90%*, indicating the plan pays for 90% of the cost for preventive services. If the `benefits.oral_exam.coverage_tier` is categorized as *preventive*, then the `benefits.oral_exam.in_network` will be *10%*, indicating the enrollee is responsible for 10% of the cost of preventive services.

### Cost Share Formats

Benefit cost shares, presented in the `in_network` and `out_of_network` keys in the plan response, are represented as the cost share the plan enrollee is responsible for. For example, if the cost share is presented as *20%*, the enrollee is responsible for 20% of the service cost while the plan will pay 80%. The most common cost share formats are included in the table below.

<table data-full-width="true"><thead><tr><th width="181.1484375">Cost Share Format</th><th width="148.28515625">Structure</th><th width="145.50390625">Example</th><th>Notes</th></tr></thead><tbody><tr><td>Standard Copay</td><td>$X</td><td>$25</td><td>A $0 copay indicates the carrier documentation presents the benefit as a $0 copay or a 0% coinsurance.</td></tr><tr><td>Standard Coinsurance</td><td>X%</td><td>20%</td><td>Coinsurances for plan benefits are presented as the cost to the enrollee.</td></tr><tr><td>Cost Share with Deductible</td><td>$X after deductible<br>X% after deductible</td><td>$25 after deductible<br>20% after deductible</td><td>This represents cost shares that come into effect after the deductible amount for the plan is reached. Prior to that, the enrollee must pay all costs from providers.</td></tr><tr><td>Benefit-specific Maximum Limit</td><td>up to $X<br>up to $X per lifetime</td><td>50% after deductible, up to $1,500</td><td>Used to specify a benefit-specific maximum limit that is separate from the higher level annual maxes. Used with ortho benefits (uncommon).</td></tr><tr><td>Not Covered</td><td>Not Covered</td><td>Not Covered<br>not covered</td><td>This denotes a benefit that is not covered by a plan - the enrollee is responsible for all costs. </td></tr><tr><td>Not Included in Carrier Documentation</td><td>null</td><td>null</td><td>This indicates that the benefit is not specified nor implied in the carrier's plan benefit documentation.</td></tr></tbody></table>

### Limit Formats

Benefit limits are included where applicable to detail standardized limitations or additional details for the benefit's cost shares. The most common limit formats are included in the table below.&#x20;

<table data-full-width="true"><thead><tr><th width="181.1484375">Limit Format</th><th width="148.28515625">Structure</th><th width="145.50390625">Example</th><th>Notes</th></tr></thead><tbody><tr><td>Standard Limit</td><td>X {measured service}(s) per {time period}</td><td>1 exam(s) per year<br>2 item(s) per 36 month(s)</td><td>For most benefit limitations, the {measured service} is an item, exam, or treatment. The {time period} is typically months or years.</td></tr><tr><td>Tooth-Based Limit</td><td>X {measured service}(s) per X tooth per {time period}</td><td>1 treatment(s) per 1 tooth per 2 year(s)</td><td>For Dental benefits, per-tooth benefit limits are commonly applied.</td></tr><tr><td>Age-Based Limit</td><td>up to age X</td><td>up to age 16</td><td>Some Dental benefits are only available to enrollees based on age. These benefits are commonly combined with Standard or Tooth-Based Limits in a comma-separated string.</td></tr><tr><td>Documentation Reference</td><td>see carrier documentation for more information</td><td>see carrier documentation for more information</td><td>The documentation reference limit is included when important information is included in the SBC or other carrier document for the benefit that is non-standardizable. This is most commonly used in cases in which the additional information could impact the amount the enrollee would pay for the benefit. This limit is also commonly used when visit limits are aggregated with other benefits.</td></tr><tr><td>No Limit Included</td><td>null</td><td>null</td><td>If no limit is included for the benefit, the limit string will return null.</td></tr></tbody></table>

### Benefits by Field

The below table includes a list of all supported benefit fields in Ideon's plan schema, ordered alphabetically by API Schema Key.&#x20;

<table data-full-width="true"><thead><tr><th width="232.6949462890625">Benefit Field</th><th width="252.692138671875">API Schema Key</th><th width="612.765869140625">Alternative Commonly-Used Terminology</th></tr></thead><tbody><tr><td>Bridges</td><td>bridges</td><td>Fixed Partial Denture, Fixed Bridge, Tooth-Supported Bridge</td></tr><tr><td>Crowns</td><td>crowns</td><td>Caps, Dental Caps, Single Restorations</td></tr><tr><td>Dentures</td><td>dentures</td><td>Complete Dentures, Partial Dentures, Removable Prosthetics, Full Dentures, False Teeth</td></tr><tr><td>Denture Relines &#x26; Rebases</td><td>denture_relines_rebases</td><td>Denture Relining, Denture Rebasing, Denture Refitting</td></tr><tr><td>Denture Repair &#x26; Adjustments</td><td>denture_repair_and_adjustments</td><td>Prosthetic Repairs, Bridge &#x26; Denture Repair, Recementation</td></tr><tr><td>Emergency Treatment</td><td>emergency_treatment</td><td>Palliative Treatment, Emergency Pain Relief</td></tr><tr><td>Endodontics</td><td>endodontics</td><td>Root Canal, Root Canal Therapy, Pulpotomy, Nerve Treatment</td></tr><tr><td>Fluoride Treatment</td><td>fluoride_treatment</td><td>Topical Fluoride, Fluoride Application</td></tr><tr><td>Implants</td><td>implants</td><td>Dental Implants, Tooth Implants, Implant Placement</td></tr><tr><td>Inlays</td><td>inlays</td><td></td></tr><tr><td>Onlays</td><td>onlays</td><td></td></tr><tr><td>Oral Exam</td><td>oral_exam</td><td>Periodic Oral Exam, Comprehensive Oral Exam, Dental Evaluation, Consultation</td></tr><tr><td>Oral Surgery</td><td>oral_surgery</td><td>Surgical Extractions, Impacted Tooth Removal, Wisdom Tooth Removal</td></tr><tr><td>Orthodontics (Adult)</td><td>orthodontics_adult</td><td>Braces (Adult), Orthodontia, Adult Orthodontic Treatment</td></tr><tr><td>Orthodontics (Child)</td><td>orthodontics_child</td><td>Braces (Child), Orthodontia, Child / Adolescent Orthodontic Treatment</td></tr><tr><td>Periodontal Maintenance</td><td>periodontal_maintenance</td><td>Perio Maintenance, Supportive Periodontal Therapy</td></tr><tr><td>Periodontics</td><td>periodontics</td><td>Gum Disease Treatment, Scaling &#x26; Root Planing, Deep Cleaning, Osseous Surgery, Gum Surgery</td></tr><tr><td>Cleaning / Prophylaxis</td><td>prophylaxis_cleaning</td><td>Prophylaxis, Routine Cleaning, Dental Hygiene, Tartar / Calculus Removal</td></tr><tr><td>Bitewing X-Rays</td><td>radiograph_bitewings</td><td>Bitewing Radiographs, Routine X-Rays</td></tr><tr><td>Other X-Rays</td><td>radiograph_other</td><td>Full Mouth X-Rays, Complete Series, Panoramic X-Ray, Panorex, Periapical Radiographs, Non-Routine X-Rays</td></tr><tr><td>Fillings</td><td>restoration_fillings</td><td>Restorations, Amalgam Fillings, Composite Fillings, Tooth-Colored Fillings, Silver Fillings</td></tr><tr><td>Sealants</td><td>sealant</td><td>Fissure Sealant, Pit and Fissure Sealant</td></tr><tr><td>Simple Extraction</td><td>simple_extraction</td><td>Tooth Removal, Basic Extraction</td></tr><tr><td>Space Maintainers</td><td>space_maintainers</td><td></td></tr></tbody></table>


---

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