Glossary

Frequently used dental insurance terms and definitions.

Starmount Life’s Glossary of
Dental Insurance Terms

  • AlwaysAssist – An online benefit management tool that helps members print ID cards, view benefit information, download forms and documents, update contact information, access health links and benefit tools, search for dental and vision providers and view claims and coverage amounts.
  • Annual/Benefit Year Maximum – The maximum amount that a plan will pay for dental care expenses incurred by the insured during a specified period – calendar year or benefit year.
  • Basic Services (Class B or II) – A category of dental procedures and services that typically includes simple restorative services (fillings) and simple extractions. There is no waiting period and a coinsurance percentage applies to the procedures and services in this category.
  • Benefit Year – The benefit period in which benefits are calculated. This period of time is not always a calendar year.
  • Calendar Year – The period of time beginning January 1 and ending December 31 of the same year.
  • Coinsurance – The fixed percentage of a covered dental expense the insured pays, after the deductible has been paid.
  • Covered Procedures – Procedures for which payment is provided under the terms of the dental insurance plan.
  • Deductible – The amount the insured is responsible for paying for covered dental expenses before the insurance carrier pays for the benefits.
  • Dependent – Spouse or child of the insured, including any other family members for whom they are the legal guardian.
  • Effective Date – The date the insured becomes eligible for benefits under a dental benefit contract.
  • Exclusions – Dental procedures and services that are not covered by the dental insurance plan.
  • Fee Schedule – A list of payment amounts to be made by an insurance carrier to the insured or to a provider for expenses incurred for covered procedures and services under fee schedule (or maximum allowable) plans. The fee schedule includes a list of charges for covered procedures which a dental provider agrees to receive for specific services and procedures.
  • In-network – Providers who have contracts to participate in specific networks and perform procedures and service, according to the guidelines, at a set rate.
  • Major Services (Class C or III) – A category of dental procedures and services that may include bridges, crowns, dentures, emergency treatment, implants, oral surgery and root canals. There is a 12 month waiting period, and a coinsurance percentage applies to the procedures and services in this category.
  • Member – An individual enrolled in a dental insurance plan.
  • Out-of-pocket costs – Any amount the insured is responsible for paying for procedures and services, such as coinsurance, deductibles and costs for non-covered services or that exceed the annual maximum.
  • Pre-treatment estimate – An estimate of the costs an insurance carrier would pay for a covered procedure or service. The remaining benefit amount, annual maximum, deductibles and co-insurance are all taken into consideration when developing this estimate.
  • Premium – The amount charged for coverage of benefits for a specified period of time according to the dental benefit contract.
  • Preventive Services (Class A or I) – A category of dental procedures and services that typically includes preventive and diagnostic procedures such as routine exams, dental cleanings, x-rays and sealants, and fluoride treatments for children. There is typically no waiting period, and depending on the dental insurance plan, a coinsurance percentage may apply to the procedures and services in this category.
  • Provider – A general dentist or specialist who performs dental care procedures and services for the insured.
  • Reimbursement – Payment made by an insurance carrier to the insured or to a provider for expenses incurred for covered procedures and services.
  • Waiting Period – A period of time an individual must be enrolled in a dental plan before becoming eligible for a specific category of benefits.

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