The Federal Advantage Plan
Glossary of Terms

Advantage Dental Plans
CompBenefits' "next -generation" of dental plans that feature fixed co-payments per dental procedure, no claims to file, no deductibles to fulfill, and no annual or lifetime benefit maximums.

Amalgam
A silver filling.

Ancillary Services
Services, other than those a provider performs, such as laboratory work, x-rays, and anesthesia.

Annual Benefit Maximum
The maximum benefit per plan member that can be received each year.

Annuitants
Federal retirees (who retired on an immediate annuity), and survivors (of those who retired on an immediate annuity or died in service) receiving an annuity. This also includes those receiving compensation from the Department of Labor's Office of Workers' compensation Programs, who are called compensationers. Annuitants are sometimes called retirees.

BENEFEDS
The enrollment and premium administration system for FEDVIP.

Benefits Schedule
A listing of the services for which a benefit plan will pay.

Bilateral
Both the right and left sides.

Bitewings
X-rays used to reveal several upper and lower teeth as patients bite down on the x-ray film.

Bleaching
A cosmetic dental procedure that whitens teeth using a bleaching solution.

Bonding
The white dental material that is applied to a tooth to change its shape and/or color. Bonding also refers to how a filling or some fixed partial dentures are attached to teeth.

Bridge
See Fixed Partial Denture and/or Removable Partial Denture. See also Pontic.

Cap
See Crown.

Caries
Commonly used term for tooth decay.

Cavity
Tooth decay.

Cementation
Placing a fixed crown or bridge with a dental cement.

Claim
Information submitted by a provider or covered person for reimbursement for services or materials.

Claims Review
Review of a claim before reimbursement is made to the provider or subscriber.

Coinsurance
A percentage of the costs of services a patient pays. This is a characteristic of indemnity insurance, POS, and PPO plans.

Composite
A white filling.

Contract Year
The period of time from the effective date of the contract to the expiration date of the contract.

Coordination of Benefits (COB)
The provision that limits benefits for members with multiple benefits plans.

Co-payment, Co-pay
A specific fee paid by the subscriber for a specific service.

Coverage
Benefits of a benefit plan.

Covered Person
An individual who meets a health plan's eligibility requirements and for whom premium payments are paid.

Covered Expenses
Expenses incurred by a covered person who qualifies for reimbursement under the terms of a policy.

Covered Services
Services for which payment is provided under the terms of a policy.

Credentialing
Approving a provider to participate in a benefit plan.

Crown
Anatomical Crown: That portion of tooth normally covered by, and including, enamel.
Abutment Crown: Artificial crown to support a dental device used to replace a missing tooth.
Artificial Crown: A crown that covers or replaces most of or the whole of the crown of a tooth.
Clinical Crown: That portion of a tooth not covered by supporting tissues.

D.D.S., D.M.D.
Academic degrees for dental practice.

Date of Service
The date that the service was provided.

Debridement
Removing foreign matter or dead tissue.

Decay
The decomposition of tooth structure.

Dental Prosthesis
An artificial device that replaces one or more missing teeth.

Denture
An artificial substitute for natural teeth and adjacent tissues.

Denture Base
The part of the denture that holds artificial teeth and fits over the gums.

Dependent
An individual who is eligible for benefits through a spouse, parent, or other family member.

Digital X-Ray
X-rays that are seen immediately on a computer screen after exposure.

Effective Date
The date on which benefits under a policy begin.

Eligibility Date
The date on which an individual member of a group becomes eligible to apply for benefits under the benefit plan.

Eligible Dependent
A dependent of a covered person (spouse, child, or other dependent) who meets all requirements specified in the contract to qualify for coverage and for whom premium payment is made.

Eligible Employee
An employee who meets the eligibility requirements specified in the group contract to qualify for coverage.

Employee Contribution
The portion of the premium paid by the employee.

Employer Contribution
The portion of the cost of a benefit plan an employer pays.

Endodontist
A dental specialist who limits his/her practice to treating disease and injuries of tooth pulp.

Enrollee
An individual covered by a benefit plan.

Evaluation
Periodic Oral Evaluation: An evaluation performed to determine any changes in the patient's oral health since a previous comprehensive or periodic evaluation.
Limited Oral Evaluation: An evaluation limited to a specific oral problem.
Comprehensive Oral Evaluation: A thorough evaluation and recording of the hard and soft tissues inside and outside of the mouth, including the evaluation and recording of the patient's dental history.
Comprehensive Periodontal Evaluation: An evaluation of periodontal conditions, probing and charting, evaluation, and recording of the patient's dental history.
Re-Evaluation: An assessment of a previously existing condition.

Exclusions
Services not covered under a benefit program.

Extraction
The removal of a tooth or tooth parts.

Fee for Service
Traditional provider reimbursement in which the doctor is paid according to the service performed.

Fee Schedule
A list of the charges for specific services to which a provider agrees.

Filling
Restoring of lost tooth structure by using materials such as metal, plastic, or porcelain.

Fixed Appliances
Braces.

Fixed Partial Denture
An artificial device that replaces one or more missing teeth that is cemented to teeth, attached to teeth or implanted to the space next to the missing tooth or teeth.

Fluoride
A natural substance known to prevent tooth decay.

Full-Mouth X-Rays
A combination of 14 x-rays that reveals all the teeth and the bone around them.

General Anesthesia
A controlled state of unconsciousness, accompanied by a partial or complete loss of reflexes.

Gingiva
The gums.

Gingivitis
Inflammation of the gums without loss of connective tissue.

Gingivectomy
The excision or removal of part of the gums.

Gingivoplasty
Surgical procedure to reshape the gums.

Health Care Providers
A provider of services, such as a dentist.

HIPAA
The "Health Insurance Portability and Accountability Act of 1996." HIPAA includes four key components: Electronic Transactions, Portability, Privacy, and Security.

Impacted Tooth
A tooth that is positioned against another tooth, bone, or soft tissue.

Implant
An artificial device specially designed to be placed surgically within or on the jawbones to replace teeth.

Implantation
Placement of an artificial or natural tooth into bone.

Impression
A mold of a tooth or teeth.

In-Network
Providers who have contracts with a benefit plan to provide services at a set rate.

Inlay
A dental restoration made outside of the oral cavity to match the form of a prepared cavity that is then placed in the tooth.

Insurer
An organization that bears the financial risk for a group for the cost of services and materials.

Insured
People covered by a benefits plan.

Intravenous Sedation/Analgesia
A medically controlled state of unconsciousness while maintaining the patient's airway, reflexes, and the ability to respond to stimulation or verbal commands. It includes a sedative and/or pain reducing IV and monitoring.

Lapse
Termination of a policy.

Liability
An obligation for a specified amount or action.

Lifetime Benefit Maximum
The total maximum benefit that can be paid to a plan member.

Limitations
Restrictive conditions stated in a benefit contract, such as age, length of time covered, and waiting periods, which affect an individual's or group's coverage.

Local Anesthesia
Anesthesia, such as Novocaine, that temporarily numbs an area of the body.

Malocclusion
Improper alignment of biting or chewing surfaces of upper and lower teeth.

Managed Care
A health care system under which providers are organized into a network in order to manage the cost, quality, and access to health care. Managed care organizations include Preferred Provider Organizations (PPOs) and Dental Health Maintenance Organizations (DHMOs).

Maximum Benefit
The maximum dollar amount a benefit program will pay toward the cost of care for an individual or family in a specific period.

Member
An individual enrolled in a benefit program.

Molar
Back teeth.

Necessary Treatment
A necessary procedure or service to maintain a patient's health.

Network
A defined group of providers.

Non-Intravenous Conscious Sedation:A medically controlled unconsciousness that maintains the patient's airway, reflexes, and the ability to respond to stimulation or verbal commands. It is given with a sedative and/or analgesic agent(s) by a method other than IV.

Non-participating Provider
Any provider who is not a part of the network of a benefit plan.

Occlusion
Any contact between biting or chewing surfaces of upper and lower teeth.

Office Visit
Services provided in the provider's office.

Oral Surgeon
A dental specialist whose practice is limited to the diagnosis, surgery, and treatment of diseases, injuries, deformities, and defects of the oral region.

Orthodontist
A dental specialist whose practice is limited to the treatment of misaligned teeth and their surrounding structures.

Paid Claims
Amounts paid to providers.

Palliative
Treatment that relieves pain.

Partial Denture
An artificial device that replaces missing teeth.

Participating Provider
Any provider who is a member of a benefit plan's network.

Pediatric Dentist
A dental specialist whose practice is limited to the treatment of children from birth through adolescence.

Pedodontist
See Pediatric Dentist.

Periodontal
Pertaining to the supporting and surrounding tissues of the teeth.

Periodontal Abscess
An infection in the gum pocket that can destroy hard and soft tissues.

Periodontal Disease
Inflammation of the gums and/or periodontal membrane of the teeth.

Periodontist
A dental specialist whose practice is limited to the treatment of diseases of the supporting and surrounding tissues of the teeth.

Periodontitis
Inflammation and loss of the connective tissue of the supporting or surrounding tooth structure.

Plaque
A soft, sticky substance, composed largely of bacteria, that accumulates on teeth.

Policy
The legal document a benefits company issues to the policyholder, which outlines the conditions and terms of the benefits, also called the policy contract or the contract.

Policy Term
The period for which a benefits policy provides coverage for eligible employees.

Pontic
An artificial tooth used in a bridge to replace a missing tooth.

Post
A device like a pin that is fitted and cemented within a prepared root canal that strengthens material that restores the affected area and/or a crown.

Pre-existing Conditions
An enrollee's health condition that existed before his/her enrollment in a benefit program.

Premium
The payment for a benefit plan.

Preventive Care
Care with an emphasis on preventing health problems before they occur.

Primary Coverage
Coverage that pays expenses first whether or not there is any other coverage. See Coordination of Benefits.

Prophy
See Prophylaxis.

Prophylaxis
A scaling and polishing procedure performed to remove plaque, calculus, and stains.

Prosthesis
An artificial replacement of any part of the body.

Prosthodontist
A dental specialist whose practice is limited to the restoration of the natural teeth and/or the replacement of missing teeth with artificial substitutes.

Protected Health Information ("PHI")
Protected Health Information is made up of two components, Health Information and Individually Identifiable Health Information. Health Information is information that relates to the past, present, or future health of the individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care. Individually Identifiable Health Information is information that can be used to identify the individual, such as a name or social security number.

Provider
A health professional that provides health care services.

Pulpectomy
Complete removal of pulp tissue from the root canal.

Pulpotomy
Surgical removal of a portion of tooth pulp to maintain the health of the remaining portion of the tooth.

Quadrant
The dental term for the division of the jaws into four parts. Each quadrant generally contains five to eight teeth.

Quality Assessment
The measure of the quality of care.

Quality Assurance
The assessment of the quality of care and any necessary changes to either maintain or improve the quality of care.

Radiograph
X-ray.

Rebase
To replace the denture base.

Regional Anesthesia
See Local Anesthesia.

Reline
To resurface the side of a denture to make it fit more securely.

Removable Appliance
Removable orthodontic devices that cause simple movements of one or several teeth.

Removable Partial Denture
An artificial device that replaces one or more missing teeth that a patient can remove.

Retainer
Orthodontic Retainer: A device to stabilize teeth following orthodontic treatment.
Prosthodontic Retainer: A part of a fixed partial denture that attaches a bridge to the adjacent tooth or implant.

Scaling
Removal of plaque, calculus, and stains from teeth.

Schedule of Benefits
See Benefits Schedule.

Sealants
Plastic placed on the biting surfaces of back teeth to prevent cavities.

Section 125 Plan
A plan that provides flexible benefits that qualifies under the IRS code to allow employee contributions with pre-tax dollars.

Specialist
A provider who has been specially trained in and practices a specific type of care other than general practice.

Subscriber
The person, usually the employee, who represents a family in a benefit program.

Temporary Removable Denture
An interim, artificial device designed for use over a limited period of time.

Temporomandibular Joint (TMJ)
The hinge between the base of the skull and the lower jaw.

Temporomandibular Joint Dysfunction
Abnormal functioning of temporomandibular joint.

Termination Date
The date on which the benefit contract expires or the date an individual ceases to be eligible for benefits.

Usual, Customary, and Reasonable (UCR)
The commonly charged fees for services within a geographic area.

Veneer
In the construction of crowns or bridges, a layer of tooth-colored material.