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Dental Insurance Vocab
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Dental Insurance Vocab
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25 Questions

1. Dentist who does not have a contract agreement with benefits carrier.

2. Reporting a more complex or more expensive procedure that was actually performed. Fraudulent.

3. Period between employment or enrollment in a dental program and the date the enrollee became eligible for benefits.

4. Organization that bears the financial risk for the cost of defined categories or services for a defined group of policy holders or beneficiaries.

5. Dental benefits program that lists an assigned amount payable for each covered service; generally amount is below the average fee charged by dentists- AKA schedule of allowance.

6. Health care coverage system which employers offer a list of options for health care benefits.

7. Reference manual by the ADA that includes the Codes on Dental Procedures and Nomenclature and other instructions tools for reporting dental services to dental benefits plan and administrators.

8. Dental benefits program in which participating dentists agree to a discounted fee schedule for services rendered to patients.

9. Restrictions stated in a dental benefits contract that limit the scope of coverage.

10. Benefit carrier that has initial responsibility for benefit payment when a patient is covered by tow or more carriers.

11. Payment made by a benefit carrier or third party payer to an enrollee or to a dentist on behalf of the enrollee as repayment of fees charged.

12. List of charges established by or agreed to by a dentist for specific dental services listed by ADA procedure codes.

13. Fee a dentist most frequently charges for a given dental service.

14. Federal assistance program; provides payment for medical care from the federal government.

15. Consolidated omnibus budget reconciliation act which allows a person to temporarily maintain insurance coverage even if he/she loses job.

16. Date an individual and/or dependents become eligible for benefits under a dental benefits contract.

17. Method of determining the primary carrier for dependent children who are covered more than one dental plan. With this method - the primary payer is the parent with the earlier date of birth by month and day - without regard to the year of birth.

18. Dental benefits program in which a dentists are paid for each covered service rendered to an eligible enrollee.

19. Person who files a claim for reimbursement of covered costs (the dentist & practice)

20. Date on which the dental benefits or contract expires or date an individual ceases to be eligible for benefits.

21. Dental benefits program in which enrollees can receive benefits only when services are provided by dentists who have signed an agreement with the benefit plan to provide treatment to eligible patients.

22. Amount charged by a dental benefits carrier for coverage.

23. Period during which employees or group members can enroll in health care programs.

24. Dental benefits program that allows 1) enrollees to receive dental treatment from any licensed dentist; 2) licensed dentist to participate; and 3) payment of benefits to either the enrollee or the dentist.

25. 12 month period of the dental contract (not always a calendar year)

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