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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 TermsFlexible, 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.

The maximum dollar amount you can receive from dental insurance during each year of your policy -- not the total amount of dental services you receive. Also called you Annual Plan Maximum. The average dental plan offers around $1000 per year for total coverage. However, not all services are covered equally by the insurance plan. Here is an example: If you visit the dentist's three times in one year: $1000 total coverage provided by dental insurance Visit One: a routine teeth cleaning that costs $100: service is completely covered by your ins...

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Dental services which typically include fillings, extractions, root canals, root planings and sealants. This may vary by policy. Basic services generally include treatments and procedures that are relatively straightforward and don't involve a significant lab expense for the dentist. Basic dental services often include: emergency care for pain relief, amalgam fillings, composite (white) fillings, sedative fillings, routine tooth extractions, root canal treatment, periodontal scaling and root planing, recementing dental crowns, and stainless ste...

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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. Today, 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.

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When teeth are missing, a bridge is comprised of two or more crowns surrounding the gap. A false tooth (or Pontic) is set in between. Bridges can restore your smile, improve the shape of your face, help you bite properly or keep remaining teeth in place. The cost of dental bridges depends on several factors: The potential need for additional procedures (such as fillings or root canals) in one or two of the adjoining teeth. The technique of the dentist and lab technician. The location of the dentist. The coverage provided by your dental in...

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This involves the removal of dental plaque to avert cavities, gingivitis and periodontal disease. People routinely clean their own teeth by brushing and flossing. Dental hygienists clean away hardened tartar not removed by routine brushing and flossing. You should visit your dentist bi-annually for professional teeth cleanings. Dental cleanings are often considered basic services and are completely covered by your insurance plans, although plans vary and you should understand your coverage before receiving any treatment or service.

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Coinsurance is the arrangement between the individual insured and the insurance company where the insured is expected to pay a portion of expenses.

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A fixed amount you pay each visit for a dental service, usually before you receive the service. The amount can vary by the type of service or policy. Copayment is a payment defined in an insurance policy and paid by an insured person each time a medical service is accessed. It is technically a form of coinsurance, but is defined differently in health insurance where a coinsurance is a percentage payment after the deductible up to a certain limit. It must be paid before any policy benefit is payable by an insurance company. Copayments do not usu...

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This is dentistry aimed at creating a more attractive, positive change to your teeth and smile. Cosmetic services include: teeth whitening and bleaching, veneers, teeth contouring and reshaping, and more. Coverage varies by policy. To make sure your dentist is skilled in cosmetic dentistry, the AACD recommends that you ask for before and after photos, references, and proof of continuing education.

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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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Dependents include the spouse and unmarried children of the policy holder. Dependent children are usually eligible for coverage to the age of 26, regardless of their eligibility for competing coverage. 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 their parent's tax return Eligible to enroll in their employer's plan

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A dental restoration procedure that caps or covers a tooth or dental implant. These are used to protect or restore a weakened or broken tooth, or to make a cosmetic change. A crown can help strengthen a tooth with a large filling when there isn't enough tooth remaining to hold the filling. Crowns can also be used to attach bridges, protect a weak tooth from breaking or restore one that is already broken.

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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. Some plans pay for certain health care services before you've met your deductible. Most dental plans have a specific dollar deductible. During the benefit period, this is the portion you must satisfy of the entirety of your coverage before your benefit plan contributes to your treatment. Plans vary. Rea...

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A denture is a prosthetic device used to replace missing teeth. Two types of dentures are available -- complete (when all teeth are missing) and partial (when some natural teeth remain). Most dental insurance providers cover some or all of the cost dentures. However, contact your insurance company to find out the specifics of what they will cover.

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A group of dental services in an open network dental benefits contract that typically includes standard procedures like oral evaluations, routine cleanings, x-rays and fluoride treatments. Categorization of these may vary. Usually, the same coinsurance percentage applies to all services grouped under diagnostic and preventive services.

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This is not a dental insurance policy. Instead, it is an alternative for percentage discounts on most dental care procedures, including checkups, cleanings and more. There are individual and family discount plans. 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. Di...

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An endodontist is a specialist dentist with additional training and qualifications in root canal treatment.

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This refers to the dental services/procedures not covered by dental insurance. All dental insurance plans can be different in this regard. Known as exclusions, limitations and cost containment, some pre-existing conditions are excluded from coverage. 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 a particular procedure.

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Explanation of Benefits is not a bill, rather a notice explaining the fees charged after a claim is processed. The explanation includes what is covered by insurance and what is expected to be paid by the patient.

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A price listing of the dental services and procedures offered. A dentist may set up her 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". Fee for service plans pay your costs only after they receive and review the bill. This means higher out-of-pocket payments for you. Managed care dental plans place more rules on the range of dentists form which you can seek care and still keep all of the plan's benefits, but they make sure the dentist u...

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Fillings are needed to replace missing tooth structure resulting from decay or external trauma. Fillings are made from a variety of materials (gold, porcelain, silver amalgam, or composite resin fillings) and cost depends on the material used. Fillings are also used to repair damaged teeth caused by grinding or nail-biting.

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FSA is an employee reimbursement program employers offer eligible employees. A Flexible Spending Accounts are primary funded with employee salary deductions and reimbursed to the employee for health care while existing as a nontaxable benefit.

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Dental insurance for a specific group of people as opposed to individual coverage. Group coverage is most often offered by an employer. Individual dental plans tend to be more expensive and have more exclusions than group dental insurance plans. Employers most often enjoy tax breaks and incentives when they participate in a group dental insurance plan. Business owners can generally deduct 100% of the premiums they pay on qualifying group health plans. You may also be able to reduce payroll taxes. Using a group dental plan from Momentum, the co...

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A removable dental device used in preventative care to keep teeth from injury or damage. designed to protect your mouth and improve your health, these guards and appliances will be custom-fitted by your dentist for optimum comfort and assistance with your condition. There are several kinds of guards that serve different purposes: NTI Appliance - a small appliance worn on either the top or bottom front teeth and prevents teeth clenching, grinding, jaw pain and headaches. Under Armour Mouthguard - specifically designed to assist athletes and at...

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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: the mildest form of periodontal disease. The gums become red, swollen and bleed easily. Caused by inadequate home care, gingivitis is reversible with pro. treatment and good oral hygiene. Gingivitis can also be attributed to factors like diabetes, smoking, aging, genetic predisposition, systemic diseases and conditions, stress, inadequate nutrition, puberty, hormonal flu...

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A dental implant is a replacement for the root or roots 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 denturesby a variety of means. Made of titanium, which is lightweight, strong and biocompatible. A material that is biocompatible will not be rejected by the body. Dental implants have the higest success rate of any implanted surgical device.

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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 contracted with your insurance company and in doing so your insurance company has agreed to pay these dentists a certain amount of money for your visits. In doing so, patients pay less for using a health care provider in the network.  

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The total dollar amount that a plan will pay to either an individual (or family all under the same plan) over the course of the enrollee's life or the life of the plan. Lifetime maximums usually pertain to a specific service or procedure, such as long-term care insurance and dental insurance. These 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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A dental insurance plan offered by Momentum Plans providing 80% coverage for all covered diagnostic and preventative dental services (exams, cleanings, bitewings, x-rays, sealants, and more), 60% coverage of covered basic restorative services (fillings and simple extractions), and 50% of other services covered under your policy (emergency treatment to relieve pain, root canal therapy, crowns, bridges and dentures, and periodontics). Deductible for the Gold dental insurance plan is $50 per individual and $150 per family (up to 4 family members)....

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A dental insurance plan offered by Momentum Plans providing 100% coverage (deductible waved) for all covered diagnostic and preventative dental services, 75% coverage of covered basic restorative services, and 50% coverage of other dental services covered under your policy. 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. Learn more about our Platinum dental insurance plan.

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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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The practice of establishing or maintaining healthy teeth and gums to prevent disease and decay. Good oral hygiene includes brushing and flossing your teeth on a regular basis. Common dental problems include dental cavities, gingivitis, periodontal diseases and bad breath. Maintaining your dental health is not only crucial to avoid toothaches and have a nice smile. Your total health depends on the health of your mouth. Tooth problems can lead to diabetes, heart disease, systemic infections, and an inability to eat or speak properly and other ma...

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Surgery for treating oral diseases, injuries and defects found in the mouth or face.

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The study and treatment of improperly aligned jaws or teeth. Orthodontic services include braces, retainers, rapid palate expander and more.

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An out-of-network provider is one which is not contracted with an insurance company for reimbursement meaning patients are responsible for the full amount charged by the doctor.

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A dental specialty focused on the oral health of children from infancy through teenage years. For the best oral health, children should have their first dental checkup six months after the appearance of the baby's first tooth, or by their first birthday.

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The percentage of the cost your dental insurance company will pay for in regards to the treatments and services you receive.

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The dental specialty studying the supporting and surrounding structures of teeth, and the diseases and states that adversely affect them.

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A biofilm which naturally forms on teeth, provides an optimal setting for bacteria which helps cavities to develop. Brushing and flossing regularly will reduce plaque buildup, your bi-annual teeth cleanings will thoroughly remove the remaining plaque your tooth brush cannot remove.

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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, you pay less for care if your provider is in your 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 Dental Association (...

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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 thro...

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Also known as endodontic therapy, a root canal is a procedure removing infected pulp from the tooth's root, and replacing it with an inert material.

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A thin, plastic coating placed in pits and fissures (the chewing surfaces) of teeth, usually molars, to prevent tooth decay.

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Otherwise known as employer-sponsored insurance, this is coverage paid, either partially or entirely, by the employer on the employees behalf usually, as part of a 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. They are seen as added expense for the company, yet this is not the case. Sponsored-employer insurance through Momentum Plans generall...

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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. Having any type of dental insurance makes employees more willing to seek preventative care. Regular checkups and cleanings lead to better oral health and overall wellbeing. Voluntary plans can contain custom options to cover everythin...

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A managed care organization which helps its members (UW employees and their families) manage the quality and cost of their healthcare. Momentum Insurance Plans is a proud partner.

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Ultra-thin shells of porcelain or a composite resin material which 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, brighten teeth and improve smiles.

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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. Waiting periods are specific to your plan and can vary service to service. Some plans have no waiting period for basic and necessary care including teeth cleanings or emergency pain relief procedures. These same plans may have 6 - 12 month waiting periods for restorative dental services though. Waiting periods are a large deciding factor when it comes to choosing the right dental plan. Getting dental insur...

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