Glossary

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  • a

  • Align
    Movement of teeth into position for a proper line of occlusion. Aligning teeth in relation to their supporting structures and opposing teeth.
  • Alzheimer's disease
    Alzheimer's disease is a progressive disease that destroys memory and other important mental functions. It's the most common cause of dementia — a group of brain disorders that results in the(...)
  • American Dental Association
    A non-profit organization dedicated to the advocacy of oral health.
  • Anesthesia
    Loss of feeling or sensation, with or without loss of consciousness.
  • Annual Limit
    A limit imposed by an insurer or employer sponsored health benefit plan on the amount of covered treatment or services that will be considered covered during a single plan year. Limits may be(...)
  • Aseptic
    Free from germs and infection.
  • Astigmatism
    A condition in which the irregular-shaped cornea (corneal astigmatism) or lens (lenticular astigmatism) causes light to focus on two points in the back of the eye rather than just one.
  • b

  • Band
    A thin strip of metal around the crown of a tooth. It may be used for orthodontic movement, for stabilization, and occasionally as a part of a restorative procedure.
  • Beneficiary
    Subscribers and dependents receiving benefits through a fully insured or self insured indemnity plan or fully insured or self-insured PPO dental plan.
  • Benefit
    1) The amount payable by a third party toward the cost of various covered dental services. 2) The dental service or procedure covered by an insurance plan.
  • Bifocal
    A lens with two focal lengths: one for distance and one for close range.
  • Biopsy
    Surgical removal of tissue for microscopic examination.
  • Bite Guard
    An appliance that is used to stabilize the teeth and/or provide a flat surface for unobstructed movement of the jaw.
  • Bleaching
    A technique used to restore a discolored tooth to its natural color.
  • Blood glucose
    Glucose is the main type of sugar in the blood and is the major source of energy for the body's cells. Glucose comes from the foods we eat or the body can make it from other substances. Glucose(...)
  • Bridgework
    Restores continuity of the teeth by replacing missing natural teeth with artificial teeth, which are attached to retainers or crowns.
  • Broker
    In insurance sales, an independent agent who does not have an exclusive contract with any single insurer or specific obligations to sell a single insurer’s products.
  • c

  • Cadillac Health Plan
    A term used to describe health coverage available through employee health benefit plans where the value of the coverage exceeds a stated annual dollar threshold.
  • Canine Teeth
    The cu spids, or teeth with a single point. They are called canines because they resemble the long teeth of a dog.
  • Cataract
    Clouding of the natural lens of the eye, usually caused by aging in conjunction with other risk factors, such as exposure to the sun’s UV rays, smoking, steroid intake, and diabetes. Symptoms(...)
  • Cavity
    A hole or weak area in a tooth caused by tooth decay.
  • Cement
    Material used to provide a seal and to bond restorations and appliances to teeth.
  • Centers for Medicare and Medicaid Services - CMS
    The federal agency within the United States Department of Health and Human Services that administers Medicare, Medicaid, CHIP, and innovations in federal insurance programs. CMS also oversees(...)
  • Children's Health Insurance Program - CHIP
    A program established in 1997 and reauthorized in 2009 which is administered by states and funded through a combination of federal and state payments. CHIP allows states to provide health(...)
  • Claim
    1) A request for payment under a dental benefit plan. 2) A statement listing services rendered, the dates of services, and itemization of costs. Includes a statement signed by the beneficiary(...)
  • CO-OP Program
    A special program established under the Patient Protection and Affordable Care Act that allows for the development of qualified non-profit health plans selling essential health benefit plans(...)
  • COBRA
    The nickname for a law enacted as part of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), that allows individuals to continue to purchase employee health benefits for a(...)
  • Community Health Center
    Non-profit clinics established under the Public Health Service Act and that provide or arrange for a broad range of primary health care services. Health centers must meet a series of federal(...)
  • Compliance
    1) The actions taken by an organization to operate in accordance with all applicable laws and regulations. 2) The functional area within an insurance company responsible for ensuring that the(...)
  • Cornea
    The clear, strong surface layer of the eye covering the iris and pupil.
  • Corneal Flap
    A layer of tissue created by a laser under which the laser treatment is performed in the LASIK procedure.
  • Cosmetic Options
    In eye wear, a lens style, coating, or feature that enhances the appearance or functionality of a lens but is not required to meet the patient’s visual needs.
  • Cost-Sharing
    A requirement that insured patients pay a portion of their medical costs, either as a deductible, or a flat dollar copayment, or as coinsurance (i.e., a percentage of the total paid claim for a(...)
  • Covered Procedures
    Procedures for which benefits are available under a dental benefit plan subject to policy provisions and limitations.
  • Crossbite
    A deviation of the teeth in one arch in relation to the opposite arch.
  • Crown
    The portion of the tooth visible above the gum, or an artificial substitute for it. A restorative crown covers the top part of a tooth that is severely damaged or weakened by decay. A(...)
  • d

  • Decay
    Decomposed tooth structure caused by bacteria.
  • Deductible
    A specified amount of eligible expenses that must be incurred and paid by the member prior to any benefits being paid.
  • Dementia
    Dementia is a general term that describes a group of symptoms-such as loss of memory, judgment, language, complex motor skills, and other intellectual function-caused by the permanent damage or(...)
  • Dental Hygienist
    A person trained and licensed to practice the art of dental prophylaxis with the direction of a licensed dentist.
  • Dental Surgery
    Cutting into, or on, live tissue in the oral cavity. Simple extraction of teeth, as well as surgical extraction, qualifies as dental surgery because of the intervention of the nerve in a vital tooth.
  • Dentistry
    The department of medicine that is concerned with the teeth, oral cavity and associated parts, including the diagnosis and treatment of their diseases and restoration of defective and missing(...)
  • Denture
    A prosthesis replacing missing teeth.
  • Department of Health and Human Services (HHS)
    The federal cabinet-level agency that administers federal health, welfare, and human services programs and activities. HHS has lead agency responsibility for significant aspects of the Patient(...)
  • Department of Labor (DOL)
    The federal cabinet-level agency responsible for administration and enforcement of the Employee Retirement Income Security Act (ERISA), a federal law that sets requirements for private(...)
  • Dependent
    For purposes of establishing eligibility for group insurance coverage, 1) a spouse or 2) an unmarried child who is under a specified upper age limit, or a disabled child of any age, who relies(...)
  • DHMO
    Defined as a Dental Health Maintenance Organization, this is a legal entity consisting of participating dental providers that provide or arrange for dental care to be furnished to a given(...)
  • Diabetes mellitus
    Diabetes is a disease that affects your body’s ability to produce or use insulin. Insulin is a hormone. When your body turns the food you eat into energy (also called sugar or glucose), insulin(...)
  • Dilation
    A process by which the pupil is temporarily enlarged with special eye drops. This allows an eye doctor to see more of the retina and look for signs of diabetic retinopathy and other eye diseases(...)
  • e

  • Effective Date
    The date a policy becomes effective to begin covering claims.
  • Employer Mandate
    A requirement that certain employers assist in the cost of coverage for workers and their dependents, either through the provision of a health plan or through contribution toward coverage via a(...)
  • Enamel
    Tooth enamel is the white, compact, very hard substance that covers and protects the tooth.
  • Erosion
    Wearing away of tooth structure by action of a chemical agent or by mechanical wear.
  • Essential Health Benefits
    The minimum level of coverage that must be offered by qualified health plans operating in state health insurance exchanges. Essential benefits are defined in relation to the classes of services(...)
  • Examination
    The act of investigation of the oral cavity using visual, radiographic, digital, and other means for diagnostic purposes.
  • Exchange
    State health insurance marketplaces whose establishment was mandated by the Affordable Care Act. Exchanges are to be established by 2014 for individuals and small employer groups (exchanges for(...)
  • Explanation of Benefits
    A written statement to a beneficiary, from a third-party payer, after a claim has been reported, indicating the benefit/ charges covered or not covered by the dental benefit plan.
  • Extraction
    Removing a tooth from the oral cavity.
  • f

  • Farsightedness (hyperopia)
    The inability to see objects up close. It is the result of an eyeball that is too short or whose outside surface (the cornea) is too flat. The exact cause is not known, although farsightedness(...)
  • Fee-for-Service
    A system of payment or provider reimbursement in which the dentist is paid according to the service performed. This is the reimbursement system used by conventional indemnity insurers.
  • Filling
    The preferred term is restoration. However, by common usage the term filling refers to restorations not requiring castings. Examples include restorations involving amalgam, acrylic resin, or(...)
  • Fissure
    A groove, cleft, or developmental fault in the tooth.
  • Floaters
    A dark or gray spot or speck that passes across the field of vision and moves as the eye moves. Floaters are very common, especially as the eye ages. Floaters are caused by undissolved matter(...)
  • Fluoride
    A solution of fluorine that is applied topically to the teeth for the purpose of preventing dental cavities. Fluoride is also added to drinking water in some areas.
  • Fracture
    A break or rupture. In the oral cavity, it may refer to the breaking of teeth or bones.
  • Fraud
    The intentional use of false information to mislead another party into parting with something of value or giving up a legal right.
  • Frequency
    The period of time that must elapse before a patient is eligible again for services. Usually listed in order of exam/lens/frame.
  • g

  • Gingivitis
    Inflammation of the gums often caused by a buildup of food particles and plaque on and around the teeth.
  • Glaucoma
    An eye disease in which the passages that allow fluid in the eye to drain become clogged or blocked, or too much fluid accumulates inside the eye. Increased pressure inside the eye then damages(...)
  • Grandfathered Plan
    A health benefit plan or health insurance policy in effect as of the date of enactment of the Patient Protection and Affordable Care Act.
  • Grievance
    A complaint against an insurer or health plan other than one involving the denial of covered benefits. An example of a grievance would be inappropriate behavior by a network provider or too few(...)
  • h

  • Halitosis
    Foul odor of the breath due to poor oral hygiene, periodontal disease, sinusitis, tonsillitis, or broncho pulmonary disease.
  • Health Insurance
    A mechanism for transferring some or all of the financial risk of incurring costs for medical or health conditions and services.
  • Health Insurance Portability and Accountability Act (HIPPA)
    Health Insurance Portability and Accountability Act – A federal law that regulates health information privacy, health insurance portability and non-discrimination and health(...)
  • healthcare.gov
    A website maintained by the Office of Consumer Information and Insurance Oversight of the Department of Health and Human Services that provides information to consumers on available insurance(...)
  • Hypersensitivity
    Abnormally sensitive teeth. The tendency to react with unusual severity to stimuli, such as heat, cold, touch, or chemical change.
  • i

  • Impacted Tooth
    Any tooth that is positioned or wedged against another tooth, bone, or soft tissue, preventing it from erupting normally.
  • Implant
    Dental implants are prostheses made of metal or other foreign material that are placed into or on the bone to provide support.
  • Incurred Expense
    An expense is considered to be incurred at the time service is rendered. For procedures that require multiple visits, the expense is considered incurred upon the initial visit; i.e. prep date of(...)
  • Inflammation
    Tissue response to irritation or injury, characterized by heat, swelling, redness, and pain.
  • Iris
    The colored ring of tissue suspended behind the cornea and immediately in front of the lens. It regulates the amount of light entering the eye by adjusting the size of the pupil.
  • l

  • LASEK (Laser-Assisted Sub-Epithelial Keratectomy)
    A hybrid of photorefractive keratectomy (PRK) and laser-assisted in-situ keratomileusis (LASIK), the goal of LASEK is the preservation of the corneal epithelium. Rather than creating a flap with(...)
  • LASIK
    A refractive procedure to correct myopia by which a flap of cornea is made, excimer laser ablation of corneal stoma is performed, and the flap laid back in position. Acronym for(...)
  • LASIK (Laser-Assisted in-Situ Keratomileusis)
    Type of refractive surgery in which the cornea is reshaped to change its optical power. A flap of the cornea is raised, and a laser reshapes the tissue in order to correct myopia, hyperopia, and(...)
  • Late Entrant
    If an employee enrolls in a benefits plan later than 31 days after becoming eligible, the person is considered a late entrant. There are many definitions set in place by insurance carriers to(...)
  • Legal Blindness
    In the U.S. there are two criteria: 1) visual acuity of 20/200 or worse in the better eye with corrective lenses; or 2) visual field restricted to 20 degrees diameter or less in the better eye,(...)
  • Lenticular
    Lenses designed to reduce weight and thickness by concentrating all the power of the lens in a small area in the center. They are often used for post-cataract surgery patients.
  • Life Insurance
    Insurance that pays a benefit upon the death of a named person.
  • Lifetime Deductible
    A specified amount of eligible expenses that must be incurred by the member prior to any benefits being paid. This is only taken once in the lifetime of the member’s policy.
  • Lifetime Limit
    An aggregate upper limit on the amount of benefits that an insurer will pay over the lifetime of a policy.
  • Lifetime Maximum
    The maximum benefit for all covered expenses, from all causes, incurred by an individual, that may be paid during his or her lifetime under the policy for specified procedures.
  • m

  • Maximum Covered Expense (MCE)
    The maximum amount a plan will reimburse for a procedure, usually shown in a list. The difference between the Maximum Covered Expense (MCE) and the actual cost of the procedure is paid(...)
  • Medicaid
    A government insurance program for people of all ages whose income and resources are insufficient to pay for health care. Medicaid is state administered and financed by both the states and the(...)
  • Medical Loss Ratio (MLR)
    A medical loss ratio (MLR) is the proportion of premium dollars that an insurer spends on health care services and certain recognized plan administration costs relative to health insurance(...)
  • Medicare
    A government program that provides hospital benefits (Medicare Part A) and medical benefits (Medicare Part B) to people age 65 or older and to some others. Dental care is not covered under(...)
  • Microorganisms
    Minute living organisms that include bacteria, viruses, yeast, and fungi. They may be present in the normal flora of the oral cavity without producing disease. Pathogenic microorganisms are(...)
  • Minimum Essential Coverage
    The minimum insurance package that fulfills the requirement of the mandate that all individuals carry insurance.
  • Molars
    Teeth located in the back of the mouth behind the bicuspids. Adults have eight molars (12 if they still have their wisdom teeth), which have a bumpy surface good for the toughest chewing jobs.
  • Mortality Rate
    The rate at which death occurs among a specified group of people during a specified period, typically one year.
  • Multifocal
    Any lens having more than one power or correction. Includes bifocals, trifocals, progressives, and quadrifocals.
  • o

  • Open Enrollment
    The period of time preceding the effective date of a group insurance policy that allows eligible employees to participate or not participate in the employer’s group insurance policy.
  • Optometrist
    A doctor of optometry (OD) who is licensed to examine, measure, and treat certain visual defects by means of corrective lenses or other methods.
  • Optometry
    The profession of examining, measuring, and treating certain visual defects by means of corrective lenses or other methods that do not require licensure as a physician.
  • Orthodontics
    The branch of dentistry concerned with the detection, prevention, and correction of abnormalities in the positioning of the teeth in relationship to the jaws.
  • Orthodontist
    A dentist who has met all requirements to qualify as a specialist in the practice of correcting misaligned teeth and jaws with braces, retainers, or other dental appliances.
  • Out-of-network
    A care provider who is not a member of an insurance carrier’s network. Patients visiting non-member doctors will be reimbursed according to the non-member allowances dictated by the group’s contract.
  • Out-of-Pocket
    The expenses not covered under an insurance policy for which a member is liable.
  • Overbite
    Vertical overlap of the upper teeth over the lower teeth.
  • p

  • Palate
    The roof of the mouth. It consists of a hard anterior part and a soft movable part. The palatal structures separate the mouth and nasal cavity.
  • Per-visit Deductible
    A specified amount of eligible expenses incurred and paid by the member for each claim prior to any benefits being paid.
  • Periodontal disease
    Periodontal diseases are mainly the results of infections and inflammation of the gums and bone that surround and support the teeth. In its early stage, called gingivitis, the gums can become(...)
  • Photorefractive Keratectomy - PRK
    A procedure involving the removal of the surface layer of the cornea (epithelium) by gentle scraping and use of a computer-controlled laser to reshape the tissue.
  • Plan Benefit
    An arrangement that apportions expenses between health plan participants and an insurer. The member shares in the cost of covered services, generally on a percentage basis. For example, when the(...)
  • Plan Year
    The calendar, policy, benefit or fiscal year on which the records of a plan are kept and/or benefits are paid.
  • Polycarbonate
    High index plastic material used to make lightweight lenses with great impact resistance. Often used for children and individuals with active lifestyles.
  • Pre-existing Condition
    A health condition that exists for a set time prior to enrollment into a health plan, regardless of whether the condition has been formally diagnosed. The Patient Protection and Affordable Care(...)
  • Preferred Provider Organization - PPO
    A managed health care plan that arranges with health care providers for the delivery of health care at a discounted cost and provides incentives for PPO members to use the health care providers(...)
  • Premium
    A specified amount of money an insurer charges in exchange for the coverage provided by an insurance policy.
  • Presbyopia
    The loss of the eye's ability to change focus to see near objects. The reasons for this loss of the power of accommodation are not yet fully known. It is conventionally said to be due to the(...)
  • Progressive Lens
    A multi-focal lens where power gradually changes from distance correction in the top half to reading correction in the bottom half with clear vision provided for the intermediate zone.
  • Prosthesis
    An artificial replacement for one or more natural teeth and/or associated structures.
  • Pupil
    The adjustable opening at the center of the iris that allows varying amounts of light to enter the eye.
  • r

  • Radiograph
    A picture produced on a sensitive surface by a form of radiation other than light; an x-ray or gamma ray photograph.
  • Refraction
    The bending of light that takes place within the human eye. Refractive errors include nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. Lenses can be used to control the(...)
  • Refractive Surgery
    A general term referring to many different procedures to correct the refractive error of the eye.
  • Reimbursement
    Payment made by a third party to a member or dentist. It is an insured arrangement in which plan benefits are established in the contract and paid for covered services rendered.
  • Restoration
    Restoring natural or ideal contour and function as a result of disease or other factors. In the oral cavity, the term relates to fillings, inlays, crowns, bridgework, partial, and complete dentures.
  • Retainer
    An appliance used to maintain the altered positions of the teeth and jaws until they stabilize.
  • Retina
    The light-sensitive layer of tissue that lines the back of the eyeball. It sends visual impulses through the optic nerve to the brain.
  • Root
    The part of a tooth that is normally within the bone and attached to it by the periodontal ligament.
  • Root Canal
    Space within the root of a tooth that contains nerves and blood vessels. A root canal procedure is performed when the nerve of the tooth becomes infected or the pulp becomes damaged. During a(...)
  • s

  • Saliva
    The digestive secretions from salivary glands into the mouth.
  • Schedule of Benefits
    1) Under a group insurance plan, a table that specifies the amount of coverage provided for each class of insureds. 2) For medical expense claim purposes, a listing of medical treatments and the(...)
  • Single Vision
    Lenses with one power, as opposed to bifocals, trifocals, quadrifocals, or multifocals.
  • Small Business Tax Credit
    A tax credit for small employers to help offset the cost of health insurance coverage provided to their employees. Eligible small businesses consist of those with 25 or fewer employees whose(...)
  • Small Group Market
    The private health insurance market for small businesses purchasing health insurance for their employees.
  • Space Maintainer
    A fixed or removable appliance placed to maintain space created by the premature loss of a tooth or teeth.
  • Splint
    An appliance constructed of metal, acrylic resin, or modeling compound designed to retain teeth in position.
  • Splinting
    Stabilization or immobilization of periodontally involved or traumatized teeth. Splinting may be accomplished with acrylic resin bite guards, orthodontic band splints, wire ligation, provisional(...)
  • t

  • Tartar
    Hard deposit or calcified bacterial plaque that sticks to the teeth and causes decay, which results in a cavity.
  • Third-party Administrator
    Claims payer who assumes responsibility for administering health benefit plans without assuming any financial risk.
  • Tinting
    Most non-glass lenses can be dyed to add color for cosmetic purposes or to reduce light transmission. Glass lenses must be made from colored glass or have color applied by vacuum coating.
  • Trifocals
    Lens with three distinct powers to correct for distance, arm’s length, and near viewing.
  • u

  • Underwriter
    An insurance company employee who 1) assesses and classifies the degree of risk a proposed insured or group represents with respect to a specific insurance product and 2) makes a decision(...)
  • Unerupted Tooth
    One that has not broken through the bone and/or gums.
  • Usual and Customary
    The usual fee is one that a dental office usually charges for a procedure. The customary fee is the amount the insurance carrier considers typical for a specific dental procedure in a specific(...)
  • UV Coating
    Lens treatment applied to absorb the harmful portion of ultraviolet light found in daylight. When applied to plastic lenses, it is actually a dye, not a coating.
  • v

  • Vision Care Coverage
    Medical expense coverage that provides the insured with benefits for expenses incurred in obtaining eye examinations and corrective lenses.
  • Vision Service Plan - VSP
    A vision company offering vision plans with an emphasis on quality service.
  • Vitality
    Presence of living dental pulp in the tooth.
  • Voluntary Participation
    Under this type of group plan the employee can choose whether he or she wants coverage. Also called a ”contributory” plan because the employee pays a portion of the premium.
  • w

  • Waiting Period
    (Employer) Defined by the employer as the period of time between an employee’s date of hire and the date they are eligible for insurance coverage. (Carrier) Defined by the insurance carrier as(...)
  • Wavefront
    A measure of the total refractive errors of the eye, including nearsightedness, farsightedness, astigmatism, and other aberrations that cannot be corrected with glasses or contacts.
  • Wisdom Teeth (Third Molars)
    Back teeth that usually come in between the ages of 15 and 25. In ancient times, humans needed these teeth to chew and grind raw food. Today many people have them removed because they are(...)
  • y

  • Young Adult
    Individuals ages 22-26 who, under the Patient Protection and Affordable Care Act, can remain covered under their parents’ employer-sponsored or individually purchased health benefit plans.

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