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Abscess
A localized inflammation due to a collection of pus in the bone or soft tissue, usually caused by an infection.
Abutment
A tooth or implant used to support a prosthesis. A Crown unit used as part of a fixed Bridge.
Accident
An event or occurrence which is unforeseen and unintended.
Accident Insurance
A form of insurance against loss by accidental bodily injury.
Adverse Selection
The tendency of persons who present a poorer-than-average risk to apply for, or continue, insurance to a greater extent than do persons with average or better-than-average expectations of loss.
Agent
An insurance company representative licensed by the state who solicits, negotiates or effects contracts of insurance, and provides service to the Policyholder for the Insurer.
Agent-brokers
Career agents who place business with companies other than their primary companies. Also known as agents of other companies, surplus brokers, or simply brokers.
Alternate Procedure
This is a procedure that is covered by the insurer instead of a more expensive procedure. This allows the patient to have cosmetically preferable services performed, and receive payment for the services that are normally covered.
Alveoloplasty
A surgical procedure used to recontour the supporting bone structures in preparation of a complete or partial denture.
Amalgam
A dental filling material, composed of mercury and other minerals, used to fill decayed teeth.
Anesthetic
A class of drugs that eliminates or reduces pain. See local anesthetic.
Anterior
Refers to the teeth and tissues located towards the front of the mouth (upper or lower Incisors and canines).
Apex
The tip or end of the Root of the tooth.
Apicoectomy
The amputation of the Apex of a tooth.
Applicant
The party applying for an insurance Policy.
Application
A form that must be completed by an individual or other party who is seeking insurance coverage. This form provides the insurance company with much of the information it will need to decide whether to accept or reject the risk.
Baby Teeth
See primary teeth.
Benefit levels
The maximum amount a person is entitled to receive for services while covered under the policy.
Benefits
The amount payable by the insurance company to a claimant, assignee or beneficiary under each coverage.
Bicuspid
A two-cusped tooth found between the molar and the Cuspid, also known as an eye tooth or canine tooth.
Biopsy
A process of removing tissue to determine the existence of pathology.
Bitewing x-rays
X-rays taken of the crowns of teeth to check for decay.
Bleaching
The technique of applying a chemical agent, usually hydrogen peroxide, to the teeth to whiten them.
Bonding
A process to chemically etch the tooths Enamel to better attach (bond) composite filling material, veneers, or plastic/acrylic.
Bone loss
The breakdown and loss of the bone that supports the teeth, usually caused by infection or long-term occlusal (chewing areas of the teeth) stress.
Bridge
A nonremovable restoration that is used to replace missing teeth.
Broker
A marketing specialist who represents buyers of property and liability insurance and who deals with either agents or companies in arranging for the coverage required by the customer.
Bruxism
The involuntary clenching or grinding of the teeth.
Cafeteria plan
Generic term for an employee benefit plan that allows employees to select among the various group life, medical expense, disability, dental, and other plans that best meet their specific needs. Also called flexible benefit plan.
Calculus
The hard deposit of mineralized Plaque that forms on the crown and/or root of the tooth. Also referred to as tartar.
Canine tooth
The second tooth from the big front tooth, commonly called the eye tooth or cuspid.
Cap
Another term for Crown; usually referring to a crown for a front tooth.
Capitation
A method of payment for health services in which a physician or hospital is paid a fixed, per capita amount for each person served regardless of the actual number of services provided to each person.
Caries
The correct technical term for decay, which is the progressive breaking down or dissolving of tooth structure, caused by the acid produced when bacteria digest sugars.
Cavity
A laymans term for tooth decay, or Caries. Also, the dental term for the hole that is left after decay has been removed.
Cement
A special type of glue used to hold a Crown in place. It also acts as an insulator to protect the tooth`s nerve.
Cementum
The very thin, bonelike structure that covers the Root of the tooth.
Certificate of insurance
A statement of coverage issued to an individual insured under a group insurance contract, outlining the insurance benefits and principal provisions applicable to the member.
Claim
A request for payment of a loss, which may come under the terms of an insurance contract. All claims must be submitted through the provider of care or on an ADA approved claim form and submitted to: Advantage Dental Plan, PO Box 1200, Redmond, OR 97756
Clenching
The forceful holding together of the upper and lower teeth, which places stress on the ligaments that hold the teeth to the jawbone and the lower jaw to the skull.
COBRA (Consolidated Omnibus Budget Reconciliation Act of 1986)
An Act that requires group health plans with 20 or more employees to offer continued health coverage for you and your dependents for 18 months after you leave your job. Longer durations of continuance are available under certain circumstances. If you opt to continue coverage, you must pay the entire premium, plus a two percent administration charge. Found most often in connection with major medical plans, the term defines, by either description, reasonableness, or necessity to specify the type and amount of expense which will be considered in the calculation of benefits. The length of COBRA is typically 18 months, but may be continued for 36 months in some case.
Coinsurance
The amount you are required to pay for medical care in a fee-for-service plan or preferred provider organization (PPO) after you have met your Deductible. The coinsurance rate is usually expressed as a percentage of charges. For example, if the insurance company pays 80 percent of the claim, you pay 20 percent.
Coinsurance provision
A stipulation found in most health insurance policies that requires an insured to pay a stated percentage, in excess of the Deductible, of all eligible medical expenses.
Combination clause
A clause in a disability income contract that specifies a point at which the definition of total disability will no longer be based on an insured`s inability to perform his or her "own occupation" but on the insured`s inability to perform "any occupation."
Combination company
A life and health insurance company that sells both industrial and ordinary insurance products.
Combination dental plan
A dental plan which contains features of both scheduled and nonscheduled plans. Typically, combination plans cover preventive and diagnostic procedures on a nonscheduled basis and other services on a scheduled basis. See also nonscheduled dental plan.
Commission
The part of an insurance premium paid by the insurer to an agent or broker for his services in procuring and servicing the insurance.
Complex rehabilitation
The extensive dental restoration involving 6 or more units of crown and/or bridge in the same treatment plan. Using full crowns and/or fixed bridges which are cemented in place, your dentist will rebuild natural teeth, fill in spaces where teeth are missing and establish conditions which allow each tooth to function in harmony with the Occlusion (bite). The extensive procedures involved in complex rehabilitation require an extraordinary amount of time, effort, skill and laboratory collaboration for a successful outcome.
Composite
A tooth-colored filling made of plastic resin or porcelain.
Composite rate
One rate for all members of the group regardless of their status as single or members of a family.
Concealment
Deliberate failure of an applicant for insurance to reveal a material fact to the insurer.
Conditions
Provisions inserted in an insurance contract that qualify or place limitations on the insurer`s promise to perform.
Consultation
A diagnostic service provided by a dentist other than the treating dentist.
Contributory
A group insurance plan issued to an employer under which both the employer and employee contribute to the cost of the plan. Seventy-five percent of the eligible employees must be insured.
Co-payment
A cost sharing arrangement in which a person pays a specific charge for a specific medical service -- say $10 for an office visit or $5 for a prescription.
Cosmetic dentistry
Any dental treatment or repair that is solely rendered to improve the appearance of the teeth or mouth.
Coverage
The scope of protection provided under a contract of insurance; any of several risks covered by a policy.
Crown
The portion of a tooth that is covered by Enamel. Also a dental restoration that covers the entire tooth and restores it to its original shape.
Crown lengthening
A surgical procedure exposing more tooth for restorative purposes.
Curettage
A deep scaling of that portion of the tooth below the gum line. Purpose is to remove Calculus and infected gum tissue.
Cuspid
See canine tooth.
Cusp(s)
The protruding portion(s) of a tooth`s chewing surface.
DDS (or DMD)
Doctor of Dental Surgery or Doctor of Dental Medicine. Degrees given to dental school graduates. Both degrees are the same; dental schools identify their graduates at their discretion as DMD or DDS.
Deciduous
See primary teeth.
Deductible
The amount of money you must pay each plan year to cover your dental expenses before your insurance policy begins to pay benefits.
Dental floss
A thin, nylon string, waxed or unwaxed, that is inserted between the teeth to remove food and Plaque.
Dental hygienist
A dental professional specializing in cleaning the teeth by removing Plaque, Calculus, and diseased gum tissue. He acts as the patient`s guide in establishing a proper oral hygiene program.
Dental maintenance organization (DMO)
An organization similar to an HMO which provides only dental care.
Dentin
The part of the tooth that is under both the Enamel, which covers the Crown, and the Cementum, which covers the Root.
Dentist-consultant
A licensed dentist who understands the underwriting intent of dental plan language as well as the accepted standards of dental practice, and who advises insurers as to the appropriateness of dental treatment.
Denture
A removable appliance used to replace teeth. A complete denture replaces all of the upper teeth and/or all the lower teeth. See also partial denture.
Dependent coverage
Insurance coverage on the head of the family that is extended to a spouse or eligible children. Certain age restrictions for children usually apply.
Direct pulp cap
The procedure in which the exposed Pulp is covered with a dressing or Cement that protects the pulp and promotes healing and repair.
Dry socket
A localized inflammation of the tooth socket following an extraction due to infection or loss of a blood clot.
Effective date
The date on which the insurance under a policy begins.
Eligibility date
The date on which an individual member of a specified group becomes eligible to apply for insurance under the (group life or health) insurance plan.
Eligibility period
A specified length of time, frequently 31 days, following the eligibility date during which an individual member of a particular group will remain eligible to apply for insurance under a group life or health insurance policy without evidence of insurability.
Eligible employees
Those members of a group who have met the eligibility requirements under a group life or health insurance plan.
Employee certificate of insurance
The employee`s evidence of participation in a group insurance plan, consisting of a brief summary of plan benefits. The employee is provided with a certificate of insurance rather than the actual insurance policy.
Employee contribution
The employee`s share of the premium.
Employee Retirement Income Security Act (ERISA)
Legislation passed in 1974 applying to most private pension and welfare plans that requires certain minimum standards to protect participating employees.
Employer contribution
The employer`s share of the premium.
Enamel
The hard, calcified (mineralized) portion of the tooth which covers the Crown. Enamel is the hardest substance in the body.
Endodontics
The dental specialty that deals with injuries to or disease