Orthodontic claims

For most of our plans, orthodontic treatment is included in the annual maximum. If the member has a shared annual maximum for orthodontic treatment, Level will cover 100% of the allowed amount, minus any previous or primary carrier payment. If the member doesn't have enough benefits, Level will pay out their remaining annual maximum. Members with these plans can use their full benefit balance at any time. 

For these members, additional benefits can be applied toward ongoing treatment when the annual maximum renews. To do that, submit a comprehensive orthodontic claim (D8080/8090) when treatment starts, and include the banding date, months of treatment, and total treatment cost. Level will pay out the member's full annual maximum. The next year, if treatment is ongoing, submit a periodic orthodontic claim (D8670) for another payout.

Some of our plans cover orthodontia in a separate lifetime maximum. For these plans, coinsurance may apply. 

Some plans may have age limits for orthodontic care, and other plans may provide no orthodontic coverage. Because rules and limitations vary between plans, it’s best to check the member’s coverage before an appointment. 

For all plans with orthodontic coverage, Invisalign and other clear aligner therapies are covered. Level pays orthodontic claims in one lump sum. 

For plans with orthodontic coverage, we cover new orthodontic cases and orthodontics in progress. For a claim initiating orthodontic treatment (D8080/D8090), make sure to include the banding date, length of treatment, and total cost of treatment. Work in progress claims (D8670) should include the banding date, length of treatment, total cost of treatment, and an explanation of benefits from the previous carrier.