the date an individual and/or dependents become eligible for benefits under a dental benefit contract. Often referred to as effective date.
Employment Retirement Income Security Act (ERISA)
a federal act, passed in 1974, that established new standards and reporting/disclosure requirements for employer-funded pension and health benefit programs. To date, self-funded health benefit plans operating under ERISA have been held to be exempt from state insurance laws. This exemption is currently under review.
hard calcified tissue covering dentin of the crown of tooth.
a dental specialist who limits his/her practice to treating disease and injuries of the pulp and associated periradicular conditions.
individual covered by a benefit plan. (see Beneficiary).
reshaping of the occlusal surfaces of teeth to create harmonious contact relationships between the upper and lower teeth; also known as occlusal adjustment.
patient who has a record of recent care.
see "periodic oral evaluation", "limited oral evaluation", "comprehensive oral evaluation", or "detailed and extensive oral evaluation".
complete separation of the tooth from its socket due to trauma (avulsion).
surgical removal of bone or tissue.
dental services not covered under a dental benefit program.
Exclusive Provider Organization (EPO)
a dental benefit plan that provides benefits only if care is rendered by institutional and professional providers with whom the plan contracts (with some exceptions for emergency and out-of-area services).
overgrowth of bone (see Torus).
1) The date on which the dental benefit contract expires. 2) The date and individual ceases to be eligible for benefits.
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.
Extension of Benefits
extension of eligibility for benefits for covered services, usually designed to ensure completion of treatment commenced prior to the expiration date. Duration is generally expressed in terms of days.
outside the crown of a tooth.
outside the oral cavity.
a material usually resulting from inflammation or necrosis that contains fluid, cells, and/or other debris.
An eye examination includes several tests that are performed by a doctor who specializes in eye health. During an exam, vision and the ability to focus are checked and other factors related to eye health are evaluated. Because many eye diseases show no symptoms, it is important to have regular, comprehensive eye exams.