A localized inflammation due to a collection of pus in the bone or soft tissue, usually caused by an infection.
An event or occurrence which is unforeseen and unintended.
A form of insurance against loss by accidental bodily injury.
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.
Career agents who place business with companies other than their primary companies. Also known as agents of other companies, surplus brokers, or simply brokers.
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.
A surgical procedure used to recontour the supporting bone structures in preparation of a complete or partial denture.
A dental filling material, composed of mercury and other minerals, used to fill decayed teeth.
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.
The maximum amount a person is entitled to receive for services while covered under the policy.
The amount payable by the insurance company to a claimant, assignee or beneficiary under each coverage.
A process of removing tissue to determine the existence of pathology.
X-rays taken of the crowns of teeth to check for decay.
The technique of applying a chemical agent, usually hydrogen peroxide, to the teeth to whiten them.
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.
A nonremovable restoration that is used to replace missing teeth.
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.
The involuntary clenching or grinding of the teeth.
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.
The second tooth from the big front tooth, commonly called the eye tooth or cuspid.
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.
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.
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.
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
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.
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.
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."
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.
The part of an insurance premium paid by the insurer to an agent or broker for his services in procuring and servicing the insurance.
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.
A tooth-colored filling made of plastic resin or porcelain.
One rate for all members of the group regardless of their status as single or members of a family.
Deliberate failure of an applicant for insurance to reveal a material fact to the insurer.
Provisions inserted in an insurance contract that qualify or place limitations on the insurer's promise to perform.
A diagnostic service provided by a dentist other than the treating dentist.
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.
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.
Any dental treatment or repair that is solely rendered to improve the appearance of the teeth or mouth.
The scope of protection provided under a contract of insurance; any of several risks covered by a policy.
A surgical procedure exposing more tooth for restorative purposes.
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.
The amount of money you must pay each plan year to cover your dental expenses before your insurance policy begins to pay benefits.
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.
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.
Insurance coverage on the head of the family that is extended to a spouse or eligible children. Certain age restrictions for children usually apply.
A localized inflammation of the tooth socket following an extraction due to infection or loss of a blood clot.
The date on which the insurance under a policy begins.
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.
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.
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.
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.
The employer's share of the premium.
An eligible individual who is enrolled in a health plan.
Surgical removal of bone or tissue.
Specific conditions or circumstances listed in the policy for which the policy will not provide benefit payments.
The overgrowth of normal bone.
The outside of the crown of the tooth.
The removal of a tooth.
The outside of the mouth.
A payment system for health care where the provider is paid for each service rendered rather than a pre-negotiated amount for each patient. This is the common payment agreement as applies to PPO health plans.
Material used to fill a cavity or replace part of a tooth.
A chemical compound used to prevent dental decay, utilized in fluoridated water systems and/or applied directly to the teeth.
Muscle fibers covered by a mucous membrane that attaches the cheek, lips and or tongue to associated dental mucosa.
The soft tissue that covers the jawbone. Also referred to as the gums.
The length of time (usually 31 days) after a premium is due and unpaid during which the policy, including all riders, remains in force. If a premium is paid during the grace period, the premium is considered to have been paid on time.
A piece of tissue or synthetic material placed in contact with tissue to repair a defect or supplement a deficiency.
A procedure which allows a member of a health plan or a provider of benefits to express complaints and seek remedies.
A contract of insurance made with an employer or other entity that covers a group of persons identified as individuals by reference to their relationship to the entity.
Insurance written on a number of people under a single master policy, issued to their employer or to an association with which they are affiliated.
Insurance covering medical expenses or income loss resulting from injury or sickness. Health insurance is a general category that includes many different types of insurance coverage, including hospital confinement insurance, hospital expense insurance, surgical expense insurance, major medical insurance, disability income insurance, dental expense insurance, prescription drug insurance, and vision care insurance. See also medical expense insurance.
Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act of 1996, known as HIPAA, includes important new - but limited - protections for millions of working Americans and their families.
1) Increase your ability to get health coverage for yourself and your dependents if you start a new job;
2) Lower your chance of losing existing health care coverage, whether you have that coverage through a job, or through individual health insurance;
3) Help you maintain continuous health coverage for yourself and your dependents when you change jobs;
4) Help you buy health insurance coverage on your own if you lose coverage under an employer's group health plan and have no other health coverage available.
Among its specific protections, HIPAA:
1) Limits the use of pre-existing condition exclusions;
2) Prohibits group health plans from discriminating by denying you coverage or charging you extra for coverage based on your or your family member's past or present poor health;
3) Guarantees certain small employers, and certain individuals who lose job-related coverage, the right to purchase health insurance;
4) Guarantees, in most cases, that employers or individuals who purchase health insurance can renew the coverage regardless of any health conditions of individuals covered under the insurance policy.
In short, HIPAA may lower your chance of losing existing coverage, ease your ability to switch health plans and/or help you buy coverage on your own if you lose your employer's plan and have no other coverage available.
Health maintenance organization (HMO)
Prepaid health plans in which you pay a monthly premium and the HMO covers your necessary medical treatment. You must choose a primary care physician from within the network to coordinate all of your care. All specialty referrals need to be authorized by your primary care physician.
Hospital confinement insurance
A type of health insurance that provides a predetermined flat benefit amount for each day an insured is hospitalized. The benefit amount does not vary according to the amount of medical expenses the insured incurs, although some policies provide higher benefit amounts if the insured is in an intensive or cardiac care unit. Also called hospital indemnity insurance.
A denture constructed for immediate placement after removal of the remaining teeth.
An un-erupted or partially erupted tooth that is positioned against another tooth, bone or soft tissue so that complete eruption is unlikely.
The four front teeth referred to as central and lateral incisors, located in the upper and lower jaws and used to cut and tear food. The central incisors are the two large teeth in the middle of the mouth and the lateral incisors are next to the central incisor, one on each side.
An independent businessperson who usually represents two or more insurance companies in a sales and service capacity and who is paid on a commission basis.
Indirect pulp cap
A procedure in which the nearly exposed Pulp is covered with a protective dressing to protect the pulp from additional injury and to promote healing and repair via formation of secondary Dentin.
Amount that an insured and each person of his or her family covered by the policy must pay before the group or individual medical insurance policy begins to pay for medical expenses.
Policies which provide protection to the policyholder and/or his/her family. Sometimes called personal insurance as distinct from group and blanket insurance.
A cast gold filling that is used to replace part of a tooth.
A system under which individuals, businesses, and other organizations or entities, in exchange for payment of a sum of money (a premium), are guaranteed compensation for losses resulting from certain perils such as fire, accident, illness, or death, under specified conditions.
A representative of an insurance company who sells insurance. An insurance agent locates prospective insurance customers, determines the insurance needs of each customer, and assists the customer in applying for insurance. Typically, an insurance agent will deliver the policy when the application is approved, will collect the initial premium, and will provide customer service to policyowners. Also called an Agent, a field underwriter, or a life underwriter.
A person or organization covered by an insurance policy, including the "named insured" and any other parties for whom protection is provided under the policy terms.
The party to the insurance contract who promises to pay losses or benefits. Also, any corporation engaged primarily in the business of furnishing insurance to the public.
Integrated dental plan
A dental plan which is part of a major medical policy.
The area between two adjacent teeth.
The area within the crown of a tooth.
The inside of the mouth.
The area pertaining to or around the lip.
Maximum amount of benefits available to a member during their lifetime.
The area pertaining to or around the tongue.
Major medical insurance
A type of medical expense insurance that provides broad coverage for most of the expenses associated with treating a covered illness or injury.
The improper alignment of biting or chewing surfaces of upper and lower teeth.
Health care systems that integrate the financing and delivery of appropriate health care services to covered individuals by arrangements with selected providers to furnish a comprehensive set of health care services, explicit standards for selection of health care providers, formal programs for ongoing quality assurance and utilization review, and significant financial incentives for members to use providers and procedures associated with the plan. The major types of managed care plans are health maintenance organizations (HMOs), point-of-service (POS) plans, and preferred provider organizations (PPOs).
The lower jaw.
The trade name that has become synonymous with any resin bonded fixed partial denture (bridge).
The act of chewing.
The upper jaw.
Maximum annual benefit
The maximum amount that the insurance company will pay toward a specific benefit in the calendar year.
Metals, classification of
The noble metal classification system has been adopted as a more precise method of reporting various alloys in dentistry commonly used in crowns, bridges and dentures. These alloys contain varying percentages of Gold, Palladium and/or Platinum. High noble contains more than 60% of Gold, Palladium, and/or Platinum (with at least 40% gold); noble contains more than 25% Gold, Palladium and/or Platinum; predominantly base contains less than 25% Gold, Palladium and/or Platinum.
A joint federal-state health insurance program that is run by the states and covers certain low-income people (especially children and pregnant women) and disabled people. In the state of Oregon, Oregon Medical Assistance Program (OMAP) provides dental insurance coverage to Medicaid recipients under the Oregon Health Plan (OHP).
An application for insurance in which the proposed insured is required to undergo some type of medical examination. The results of the medical examination are then reported to the insurance company.
Medical expense insurance
Any of several types of health insurance designed to pay for part or all of an insured's health care expenses, such as hospital room and board, surgeon's fees, visits to doctors' offices, prescribed drugs, treatments, and nursing care. See also hospital confinement insurance, hospital-surgical expense insurance, major medical insurance, and specified expense coverage.
The federally sponsored health insurance program of hospital and medical insurance primarily for people aged 65 and older.
Medical expense coverage that provides benefits for certain expenses not covered under Medicare. This coverage is available only to individuals who are covered by Medicare and can be purchased by individuals or by employers to cover retired employees.
A person covered under the health plan (includes dependents).
The broad, multicusped back teeth, used for grinding food are considered the largest teeth in the mouth. In adults there are a total of twelve molars (including the four wisdom teeth, or third molars), three on each side of the upper and lower jaws.
MSA (Medical Savings Account)
A tax-advantaged personal savings account used in conjunction with a high Deductible health insurance policy. Individuals may contribute the equivalent of the annual deductible into this tax-deferred savings account. These moneys are set aside for qualified medical care expenses.
A controlled mixture of nitrogen and oxygen gases (N2O) that is inhaled by the patient in order to decrease sensitivity to pain. Also referred to as laughing gas.
A term applied to employee benefit plans under which the employer bears the full cost of the benefits for the employees. One hundred percent of the eligible employees must be insured.
Nonscheduled dental plan
A dental plan which pays benefits for procedures based on the dentist's actual charges, as long as the charges are usual, customary, and reasonable.
An intraoral x-ray taken with the film held between the teeth in biting position.
The chewing surface of the back teeth.
Any contact between biting or chewing surfaces of upper and lower teeth.
Open enrollment period
A period during which members can elect to make changes to coverage or add eligible dependents without proving insurability.
The removal of teeth and the repair and treatment of other oral problems, such as tumors and fractures.
A specialized branch of dentistry that corrects Malocclusion and restores the teeth to proper alignment and function. There are several different types of appliances used in orthodontics, one of which is commonly referred to as braces.
A condition in which the upper teeth excessively overlap the lower teeth when the jaw is closed. This condition can be corrected with orthodontics.
The hard and soft tissues forming the roof of the mouth.
Treatment that relieves pain but is NOT curative.
A removable appliance used to replace one or more lost teeth.
The specialized branch of dentistry that deals solely with treating children's dental disease. Also referred to as pedodontics.
The area that surrounds the root tip of a tooth.
An inflammation of the gum tissue around the crown of a tooth, usually the third molar.
Relating to the tissue and bone that supports the tooth (from peri, meaning "around," and odont, "tooth").
The inflammation and infection of gums, ligaments, bone, and other tissues surrounding the teeth. Gingivitis and Periodontitis are the two main forms of periodontal disease. Also called gum disease or pyorrhea.
An abnormal deepening of the gingival crevice. It is caused when disease and infection destroy the ligament that attaches the gum to the tooth and the underlying bone.
A surgical procedure involving the gums and jawbone.
The dental speciality that deals with and treats the gum tissue and bone that supports the teeth.
Inflammation of the supporting structures of the tooth, including the gum, the periodontal ligament, and the jawbone.
The area which surrounds a portion of the root of the tooth.
The thirty-two adult teeth that replace the baby, or primary, teeth. Also known as secondary teeth.
A recessed area found on the surface of a tooth, usually where the grooves of the tooth meet.
A film of sticky material containing saliva, food particles, and bacteria that attaches to the tooth surface both above and below the gum line. When left on the tooth, it can promote gum disease and tooth decay.
Point-of-service (POS) plan
A type of managed care plan combining features of health maintenance organizations (HMOs) and preferred provider organizations (PPOs), in which individuals decide whether to go to a network provider and pay a flat dollar Co-payment (say $10 for a doctor's visit), or to an out-of-network provider and pay a Deductible and/or a Coinsurance charge.
A written document that serves as evidence of an insurance contract and contains the pertinent facts about the Policyholder, the insurance coverage, the Insured, and the Insurer. It states the terms of the insurance contract and is issued to the policyholder by the company.
A person who pays a premium to an insurance company in exchange for the insurance protection provided by a policy of insurance.
A dental condition of an insured which first manifested itself prior to the issuance of his/her policy or which existed prior to issuance and for which treatment was received. A dental condition that existed before the effective date of coverage.
Preferred provider organization (PPO)
A network of care providers that have agreed to provide services to a health plan's members at discounted costs. PPO members typically make their own decisions about their health care rather than going through a primary care physician like an HMO member. The cost to use physicians within the PPO network is less than using a non-network provider.
The monthly amount you or your employer pays in exchange for insurance coverage.
Education and treatment devoted to and concerned with preventing the development of dental disease.
Any action taken by the patient, assisted by the dentist, hygienist, and the office staff, that serves to prevent dental or other disease. Sealants, cleanings and space maintainers are examples of preventive treatment.
Primary care dentist
A primary care dentist is usually your first contact for dental care. This is usually a general dentist. The primary care dentist makes referrals to specialists when necessary. Advantage Dental Plan does not require a PCD. Northwest Dental Services (NWDS) patients must choose a PCD.
Primary care physician
Usually your first contact for health care under a health maintenance organization (HMO) or point-of-service (POS) plan. This is often a family physician, internist, or pediatrician. A primary care physician monitors your health, treats most health problems, and authorizes referrals to specialists, if necessary.
The first set of teeth that humans get, lasting until the permanent teeth come in. Also referred to as deciduous teeth or baby teeth.
The dental specialty dealing with the replacement of missing teeth and other oral structures.
Any dentists, denturist, oral hygienist who is licensed to provider dental services in the state where coverage is provided.
The dental term for the division of the jaws into four parts, beginning at the midline of the arch and extending towards the last tooth in the back of the mouth. There are four quadrants in the mouth; each quadrant generally contains five to eight teeth.
A price estimate given to the potential consumer as he/she decides to which company a formal application will be submitted. Quotes are obtained through your broker/agent. Only your Agent of Record can obtain a quote from Advantage Dental Plan.
The pricing factor upon which the insurance buyer's premium is based.
Reasonable and customary charge
A charge for health care, which is consistent with the going rate or charge in a certain geographical area for identical or similar services.
A condition characterized by the abnormal loss of gum tissue due to infection or bone loss.
When a dental patient from one office is sent to another dentist, usually a specialist, for treatment or consultation. Also a formal process that authorizes an HMO member to get care from a specialist or hospital. This referral usually comes from your primary care physician.
The payment of the expenses actually incurred as a result of an accident or sickness, but not to exceed any amount specified in the policy. To be reimbursed you must submit a claim to Advantage Dental Plan on a current ADA claim form.
Continuance of coverage under a policy beyond its original term by the insurer's acceptance of the premium for a new policy term.
The return of a tooth to its socket.
The breakdown and assimilation of the bone that supports the tooth, i.e., bone loss.
Root canal therapy
The process of treating disease or inflammation of the Pulp or Root canal. This involves removing the pulp and root's nerve(s) and filling the canal(s) with an appropriate material to permanently seal it.
A composite material used to seal the decay-prone pits, fissures, and grooves of children's teeth to prevent decay.
Section 125 Plan
A plan which provides flexible benefits and qualifies under the IRS code which allows employee contributions to be deducted with pre-tax dollars.
The hole in the jawbone into which the tooth fits.
A dental appliance that fills the space of a lost tooth or teeth and prevents the other teeth from moving into the space. Used especially in orthodontic and pediatric treatment.
Student age limit
Stipulated maximum age above which the company will not provide coverage to a dependent.
Relating to the whole body.
Temporomandibular joint (TMJ)
The connecting hinge mechanism between the upper jaw and the base of the skull.
Temporomandibular joint (TMJ) syndrome
The problems associated with Temporomandibular joint (TMJ), usually involving pain or discomfort in the joints and ligaments that attach the lower jaw to the skull or in the muscles used for chewing. TMJ Syndrome is not generally covered under dental insurance unless a special TMJ rider is purchased.
The last of the three molar teeth, also called wisdom teeth. There are four third molars, two in the lower jaw and two in the upper jaw, one on each side. Some people are born without third molars.
Tooth Number Reference
A bony elevation or protuberance of normal bone. Usually seen on the upper palate behind the front teeth or under the tongue inside the lower jaw.
A list of the work the dentist proposes to perform on a dental patient based on the results of the dentist's x-rays, examination, and diagnosis. Often more than one treatment plan is presented. Be sure to discuss your treatment plan with your dentist. Ask about costs and payment options at the time the treatment plan is presented to you. Ask about alternative procedures and the costs associated with them. These issues are better discussed during the treatment plan rather than when the procedures are complete. Then it is to late to look at alternative treatments.
A company that receives the premiums and accepts responsibility for the fulfillment of the policy contract, the company employee who decides whether or not the company should assume a particular risk, or the agent who sells the policy.
The process of selecting risks for insurance and determining in what amounts and on what terms the insurance company will accept the risk.
An artificial filling material, usually plastic, composite, or porcelain, that is used to provide an aesthetic covering over the visible surface of a tooth. Most often used on front teeth.
The length of time an employee must wait from his date of employment or application for coverage to the date his insurance is effective. This usually varies for different types of services. Please check your member handbook and policy documents for details. Also, in most cases the waiting period can be waived if you can provide proof of prior coverage. See Certificate of Insurance and Employee certificate of insurance