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Do you ever wonder what all those fancy terms on your dentist office receipts mean? Cut through the dense fog of insurance terminology with our handy little guide; you can understand the basics by understanding the ABC’s of dental insurance lingo.
Here are some of the most commonly used terms you’ll want to be familiar with when paying for your dental work:
Accumulation Period
Length of time an individual has to incur covered expenses to satisfy a required deductible and/or calendar year or plan year maximum.
Annual Maximum Benefit
Maximum dollar amount paid by the dental plan in a calendar year or plan year.
Benefit Accumulations
Amount that has been paid for a covered person during the calendar year or plan year.
Benefit Plan Document
Generic term for a legal document detailing a member’s or group’s coverage. This document usually is referred to as a Certificate of Coverage, Certificate of Insurance or Summary Plan Description.
Billing Provider
Any eligible person, physician, doctor’s office, hospital, dentist or facility licensed to perform services.
Certificate of Insurance
Legal document detailing a member or group coverage.
COBRA
Consolidated Omnibus Budget Reconciliation Act; federal legislation regarding the continuation of health benefits for all types of employee benefit plans provided by the employer.
Con-Insurance
The arrangement between the insurance carrier and the insured in which the insured pays a specified portion of covered expenses.
Co-Payment
A cost sharing arrangement in which a member pays a specified charge for a specified service.
Continuation
State or federal (COBRA) option for a member who no longer qualifies as an active employee but can extend his or her insurance coverage for a specific amount of time. The member is responsible for any premium. This generally applies to medical coverage only, but can include dental depending on legislation and group size. Coverage and premium are the same as the group’s.
Definitions taken from Human Dental.
