Dental Application

Templates

Dental Application

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Insurance

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Datapoint

Description

This is some text inside of a div block.

Carrier Name

Identifies the insurance company providing the dental coverage.

Plan Name

Specifies the full name of the dental insurance policy plan, typically listed at the top of the document.

Policy Effective & Expiration Dates

Indicates the start and end dates of the dental policy term in MM/DD/YYYY format.

Named Insured

Returns the full name of the individual or entity covered under the dental policy.

Individual Deductible

Shows the dollar amount an individual must pay before coverage begins, often for in-network services.

Family Deductible

Shows the total deductible amount required for a family unit under in-network care.

Maximum Annual Benefit

Returns the annual dollar limit the plan will pay for covered dental services.

Preventive Services

Covers routine services like cleanings, exams, and X-rays. This field captures the coinsurance or percentage covered.

Basic Restorative Services

Returns the coverage level for services such as fillings and non-surgical extractions.

Major Restorative Services

Captures the benefit level for more complex treatments like crowns, bridges, or dentures.

Eligibility

Provides a description of who qualifies for coverage under the dental plan.

Installment Options

Returns any available payment schedule options, such as monthly, quarterly, or annual payments.

Total Estimated Annual Premium

Reflects the total expected premium for the policy year, inclusive of taxes, fees, and surcharges.

Exclusions and Limitations

Lists services or conditions not covered by the dental policy, or those covered with restrictions.

A dental insurance application includes detailed information about the policyholder, carrier, coverage levels, and premium structure—covering preventive, basic, and major dental services.

Feathery’s AI extracts this data automatically, including policy dates, deductibles, annual benefit limits, eligibility, exclusions, and premium amounts. This streamlines application processing, reduces manual entry, and accelerates policy setup and review.

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