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Dental Insurance Glossary

Oral Care and Dental Insurance Terms and Definitions

Dental insurance policies are complicated and can be difficult to understand. They are full of technical terms relating to your plan, dental services and procedures covered under your dental insurance, and oral health in general. Without knowing the definition of every word, how can you know if your dental insurance plan includes everything you need? To help you unravel the complexity of your Madison dental insurance plan, we’ve provided a glossary defining all the common dental insurance terms, as well as terms related to dental services and oral care. From Annual Maximum to Periodontics and from Deductible to Veneers, learn the terms you need to know in order to understand your insurance policy.

Dental Insurance Terms GlossaryFlexible, Affordable Dental Insurance You Can Understand


Do you need coverage for cosmetic dentistry, or do you only need diagnostic and preventative services?

Are you looking for group dental coverage or individual dental coverage?

What’s the difference between a copayment and a premium?

Do you want employer-sponsored or voluntary group dental insurance for your company?

Is the Momentum Gold or Platinum Dental Insurance right for your family?

Find out the answers to these questions and the definitions of many other dental insurance terms so you can make an informed decision about your oral health care. High-quality dental insurance does not have to be impossible to comprehend. With the help of our glossary, you can learn the words you need to know to choose the right dental coverage.

Contact our Wisconsin dental plan providers for more help understanding your dental insurance plan and get dental insurance quotes today!

Also known as your Annual Plan Maximum, this plan is the maximum dollar amount you can receive from dental insurance during each year of your policy. It DOES NOT include the total amount of dental services you receive. The average dental plan offers around $1000 per year for total coverage. However, not all services are covered equally by the insurance plan. Here's a breakdown: If you visit your dentist 3x in one year = $1000 total coverage provided by dental insurance Visit #1: Routine teeth cleaning that costs $100 Service is complet...

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Basic restorative services generally include treatments and procedures that aren't complex and don't involve a significant lab expense for the dentist. These services typically include: Fillings (amalgam, composite, and sedative) Extractions Root canals Root planings Sealants Emergency pain relief Recementing dental crowns Stainless steel crowns **This may vary by policy**

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An orthodontic treatment to correct "bad bites" and to straighten crowded or crooked teeth. Combined with other orthodontic procedures, braces can also be used to help shape jaws if they don't meet properly or to widen the palate. There are several types of braces options available. When it comes to braces and orthodontics, it is important to know what your insurance covers and how that coverage differs for children, teens, and adults. Learn more about our individual dental insurance plans and get a dental insurance that covers evertything yo...

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A dental bridge literally fills the gap created by a missing tooth. Bridges can restore your smile, improve the shape of your face, help you bite properly, or keep remaining teeth in place. There are 3 main types of dental bridges: Traditional, Cantilever, and Maryland bonded. A traditional bridge is made up of two or more crowns that surround the gap and the false tooth (or Pontic) that is placed in the gap. These are the most common types of bridges and are either made of porcelain fused to metal or ceramics. Cantilever bridges aren't very...

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Dentists recommend everyone should routinely clean their own teeth, which includes brushing and flossing twice a day. Even though you think your regimen is pretty effective, regular cleanings done by a professional dental hygienist are an absolute must. This involves the removal of dental plaque to avoid cavities, Gingivitis, and Periodontal Disease. You should visit your dentist 2x a year for professional teeth cleanings. Dental cleanings are often considered basic services and are completely covered by your insurance plans. Special plans m...

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Coinsurance is the arrangement between the insured individual and the insurance company where the insured is expected to pay a percentage of expenses. Coinsurance can cover dentist visits, certain procedures, and medications. What's the difference between copay and coinsurance? Copay and coinsurance are similar, but copay requires a flat-rate fee instead of a percentage for payment. Coinsurance only applies after the deductible is met. The deductible varies according to your dental insurance plan. Check your plan for more details.

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Copayment, also known as copay, is a fixed amount you pay for every dental visit, usually before you receive the service. The copay amount can vary by the type of visit, lab test, or prescription drugs, according to the insurance policy. Copay doesn't kick in until your deductible has been met. What's the difference between copay and coinsurance? Copay is technically a form of coinsurance, but is defined differently due to its flat-rate fee versus coinsurance's percentage payment. Copay usually doesn't contribute towards any policy's out-of-...

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Cosmetic dentistry includes certain dental procedures that result in a more attractive smile and better-looking teeth. The need for cosmetic dentistry is strictly for outward appearance - nothing medically necessary. Cosmetic services include: teeth whitening and bleaching, veneers, teeth contouring and reshaping, and more. Before you consult cosmetic dentistry professional, the American Academy of Cosmetic Dentistry (AACD) recommends that you ask for before and after photos, references, and proof of continuing education. **Insurance coverage...

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This term describes the overall scope of your dental insurance and what treatments are covered, what dentists you can go to, and what copays, deductibles and maximum benefits are provided. Most coverages are based on the policy year which may not coincide with the calendar year. Coverage also refers to how much the insurance provider will pay. For instance, 50% coverage on a $100 procedure would cost you $50 out of pocket. Coverage varies depending on your plan, and typically dictates premium costs (higher coverage generally results in higher...

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A covered dependent includes the spouse and unmarried children of the policy holder. Dependent children are usually eligible for coverage until they turn 26 years old, regardless of their eligibility for competing coverage. Eligible children include: Biological children Stepchildren Foster children Children under your legal guardianship Children legally adopted by your or spouse Children can join or remain on a parent's plan even if they are: Married Not living with their parents Attending school Not claimed as a dependent on t...

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Crowns are a type of dental restoration procedure that caps or covers a bad tooth or dental implant. They are typically made from gold, ceramics, or porcelain fused to metal. Crowns are used to protect or restore a weakened or broken tooth, and can even help strengthen a tooth with a large filling when there isn't enough tooth remaining to hold the filling structure. Crowns can also be used for: Cosmetic purposes Attaching bridges Covering discolored or oddly-shaped teeth Crowns are made from various materials, including: Stainless ...

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The deductible is the amount you owe for covered health care services before your health insurance plan begins to pay. For example, if your deductible is $1000, your plan won't begin to pay until you have already paid $1000 for covered services. After your deductible is met, you will typically pay a copay or coinsurance - insurance covers the rest. Most dental plans have a specific dollar deductible. There are certain insurance plans that pay before you've met your deductible. Other plans even pay full cost of specific preventive care before y...

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A denture is a prosthetic device used to replace missing teeth. There are two types of dentures: complete and partial. Complete dentures are needed when all of the natural teeth have been removed. They can be either conventional or immediate. Conventional dentures are ready for placement in about 8-12 weeks after teeth removal. Immediate dentures are a temporary solution until the conventional dentures are made. Partial dentures are a removable denture or bridge that is attached to a gum-colored base. This type of denture is only needed if so...

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A discount dental plan is designed for groups, families, and individuals looking to save money on dental care, which might include checkups, cleanings, and more. It is not a dental insurance policy. A dental discount plan is like a membership program, you pay an annual fee to join and you get access to discounted services at participating dentists. Discount dental plans are not for everyone. While some people prefer them for their simplicity and low price point, they miss out on the coverage provided by an insurance policy. Discounts can var...

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Exclusions, also known as limitations or cost containment, are the dental services and procedures that are not covered by dental insurance. Dental plans may use the terms "Usual, Customary and Reasonable" (UCR) to determine the portion of the dental treatment fee they are willing to pay for. All dental insurance plans can differ in exclusions. Even some pre-existing conditions are excluded from coverage. See Momentum's Exclusions policy. Why do insurance companies have exclusions? Exclusions are used for certain risks that usually can be con...

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A fee schedule is the price listing of the dental services and procedures offered in an insurance plan. A dentist may set up their own fee schedule or may agree to use one that is part of a dental plan. There are two different types of dental plans: "fee-for-service" or "managed care". The Fee-for-Service (FFS) Plan (non-PPO), also known as an idemnity plan, pays your costs only after the insurance company receives the bill and you've paid your portion. This plan is more traditional in its approach, but it typically means higher out-of-pocket ...

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A filling is a type of material that fills in a part of a tooth structure that has been damaged from decay or external trauma. External trauma can include grinding, nail-biting, cracking, breaking, or general wear and tear. Fillings are made from a variety of materials, including: Gold- lasts more than 20 years, but requires several visits and can be expensive Porcelain- can be made to match the color of the tooth and resists staining Silver Amalgam- resists basic wear and tear, but is more noticeable because of its dark color Composite ...

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A Flexible Spending Account (FSA), also known as a flexible spending arrangement, is an employee reimbursement program that employers offer to eligible employees. The account can be used to pay for copay, deductibles, drugs, and other healthcare costs. An FSA is primary funded with employee salary deductions and reimbursed back to the employee for health care, while existing as a nontaxable benefit.

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Group dental coverage is reserved for a specific group of people, as opposed to individual coverage. Group coverage is most often offered by an employer. What are the benefits of having group dental insurance? -Employers most often enjoy tax breaks and incentives -Business owners can generally deduct 100% of the premiums they pay -Payroll taxes may even be reduced -Makes preventative dental care more affordable Using a group dental plan from Momentum Insurance Plans, the costs of going to the dentist decrease. There are different types of...

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Guards and appliances are removable dental devices used in preventative care to protect teeth from damage. Mouth guards and appliances will be custom-fitted by your dentist for optimal comfort. There are several kinds of guards that assist with different issues: The NTI Appliance is a small appliance worn on either the top or bottom front teeth and prevents clenching and grinding, which can lead to jaw pain and headaches. The Under Armour Mouthguard is a particular mouth guard that is specifically designed to assist athletes whenever they cl...

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Periodontal disease is a leading cause of tooth loss and may be associated with other chronic diseases including diabetes and heart disease. Types of Gum Disease: Gingivitis is the mildest form of periodontal disease, which can caused by inadequate home care. The disease can also be attributed to factors like diabetes, smoking, aging, genetic predisposition, systemic diseases and conditions, stress, inadequate nutrition, puberty, hormonal fluctuations, pregnancy, substance abuse, HIV infection, and certain medications. Signs of gingivitis in...

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A dental implant is a replacement for the root of a tooth. Dental implants are secured in the jawbone and are not visible once surgically placed. They are used to secure crowns, bridgework, or dentures by a variety of means. Dental implants are typically made of titanium, which is lightweight, strong, and biocompatible (won't be rejected by the body). They also have the highest success rate of any implanted surgical device. There are two types of safe dental implants: Endosteal implants are surgically implanted into the jawbone. A second sur...

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Also known as fee-for-service plans, this type of coverage allows the widest choice of dentists. Unlike traditional insurance, dentists are not typically reimbursed at the same rate as a PPO. As a result, you may pay more for dental care. These are the oldest and most liberal type of health insurance plan. Today these plans are fairly expensive because the insurers don't require members to use specific hospitals or doctors, so they often get no discount for services. Indemnity plans can be the best choice for people who want ultimate freedom an...

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An in-network provider is a dentist that has a contract with your insurance company and can provide dental care to those policyholders. The insurance company agrees to pay these dentists a certain amount of money for your visits, which leads to patients paying less for using a health care provider in their insurance plan's network.

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The Lifetime maximum benefit is the total dollar amount that a plan will pay to an individual or family over the course of the policyholder's life or the life of the plan. Lifetime maximums usually pertain to non-essential services, but it depends on what those services are - according to the insurance company. A Lifetime maximum benefit's limits can vary widely, from as little as $30,000 - Unlimited (no maximum). The cost of medical care is ever rising, so a high limit is important.

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Otherwise known as exclusions, this refers to what is not covered by dental insurance. All dental insurance plans can be different in this regard. Examples of coverage limitations include: pre-existing conditions, cosmetic surgery, non-traditional treatments, home care and private nursery care, mental health treatment and common drug benefit exclusions.

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The Momentum Gold Dental insurance plan is a dental insurance plan provides 80% coverage for all covered diagnostic and preventative dental services, which include exams, cleanings, bitewings, x-rays, sealants, and more. The plan also provides 60% coverage of covered basic restorative services, which includes fillings and simple extractions. Other services that are 50% covered under this policy include: Emergency treatment to relieve pain Root canal therapy Crowns Bridges Dentures Periodontics The deductible for the Gold Dental Insu...

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The Momentum Platinum Dental Insurance Plan provides 100% coverage (deductible waved) for all covered diagnostic and preventative dental services. The plan also covers 75% of basic restorative services, which includes fillings, sealants, and crowns, and 50% of other dental services. The deductible for the Platinum Dental Insurance Plan is $50 per individual and $150 per family (up to 4 family members). The annual maximum benefit of this plan is $1,200 dollars per person, per benefit year.

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A network of dentists which has agreed to provide dental services to a health insurance plan's members at a discount. Your cost to use network providers is usually less than using non-network providers. Non-network providers cost more for a number of reasons. The provider is not bound to the price set by your insurer and your plan might require that you pay higher co-pays or deductibles, or even an out of network fee. Sometimes your plan won't cover non-network care at all. Finding a plan with a good network and non-network coverage is ideal....

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Orthodontics, also known as dentofacial orthopedics, is the study and treatment of improperly aligned jaws or teeth. Orthodontic services include braces, retainers, rapid palate expanders, and more.

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An out-of-network provider is one who is not contracted with an insurance company for reimbursement. This means that the patient is responsible for the full amount charged by the doctor, dentist, or other healthcare professional.

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Pediatric dentistry is a special branch of the dental industry that focuses on the oral health of children, from infancy through teenage years. For the best oral health, children should have their first dental checkup 6 months after their first tooth, or by their 1st birthday.

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Periodontics is the study of the supporting and surrounding structures of teeth, and the diseases and conditions that affect them. A Periodontist is a person who practices this special form of dentistry.

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Plaque is a bacterial biofilm that naturally forms on teeth and assists in cavity development. Regular brushing and flossing helps reduce plaque buildup, and results in a more enjoyable dental cleaning visit. Though some plaque cannot be removed by regular brushing and flossing, bi-annual teeth cleanings will thoroughly remove the remaining plaque.

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A PPO is a type of plan where a group of dental care providers join together to create a network of options for those with qualifying coverage. Generally, a patient will pay less for care if the provider is within the right network. Momentum Plans is part of the Unity UW Health Dental Provider Network. Find a dental care specialist near you from our premier Wisconsin providers. You may choose to see a dentist from outside your network, though this will usually lead to higher costs. All our providers are credited and certified by the American D...

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The specific rate you pay for active dental coverage. Generally, this is paid monthly, quarterly, or annually. In order to maintain your insurance coverage, you must pay your premium every month. If you miss a payment, you might lose coverage for that month. Premiums are different from deductibles or co-pays because premiums must be paid in order to receive any coverage at all. Momentum's Easy Premiums Help You Stay Covered Momentum makes paying your premiums easy! Set up reoccurring payments when you enroll or simply pay your bill online th...

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A root canal, also known as endodontic therapy, is a procedure that removes infected pulp from the tooth's root, and replaces it with an inert material. Though a root canal can be uncomfortable, there are several benefits to having the procedure, including: Natural appearance Normal biting and feeling Efficient chewing Protects other teeth from excessive wear

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A sealant is a thin, plastic coating placed in the pits and fissures (the chewing surfaces) of the tooth to prevent decay. The sealant acts as a protective shield of the tooth's enamel. The molars, or teeth at the back of the mouth, are the typical target for sealant treatment.

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Sponsored-employer insurance, or also known as employer-sponsored insurance, is paid for by a business on an employee's behalf, either partially or entirely. This type of insurance is usually part of a employee benefits package. However, dental and vision insurance are not required as part of an overall healthcare package under the Affordable Care Act. Since employer-provided dental plans are not mandatory, they are often not offered in order to save money. Unfortunately, they are seen as added expense for the company, but this is not the case...

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Employer-sponsored dental insurance allows employees to opt in or out of coverage. By allowing employees the opportunity to opt out, they are able to save on health care expenses. Additionally, the employees pay the premiums, sometimes from a payroll deduction while the employer only makes a smaller contribution. Regular checkups and cleanings lead to better oral health and overall well-being. Providing some type of dental insurance makes employees more willing to seek preventative care. Voluntary plans provide custom options to cover everythi...

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The Unity State UW Health Network is a managed care organization that helps its members (UW employees and their families) manage the quality and cost of their healthcare. Momentum Insurance Plans is a proud partner with the network and provides affordable dental insurance for Wisconsin residents.

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Veneers are ultra-thin shells of porcelain or a composite resin material that are bonded to the front of teeth. This can significantly improve the appearance of the front teeth, as well as protect them from damage. Veneers mask discolorations, hides chips on the edge of the tooth, closes gaps, brightens teeth, and improves the overall smile.

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A set amount of time a person must be a member of a dental insurance plan before they are eligible to receive the benefits from their plan. Dental insurance waiting periods are specific to your plan and can vary from service to service. Some plans have no waiting period for basic and necessary care, including teeth cleanings or emergency pain relief procedures. If you need restorative dental services, these same plans might have 6 - 12 month waiting periods. Waiting periods are a large deciding factor when it comes to choosing the right dental...

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