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Dental Insurance Glossary
Affordable Care Act (ACA) The comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or “Obamacare”). The Affordable Care Act (ACA), or Obamacare, names pediatric dental benefits one of the 10 essential health benefits that must be included in certain health plans under Obamacare. However, ACA doesn't include adult dental insurance
Accident Benefit Accident insurance helps you pay for the medical and out-of-pocket costs that you may incur after an accidental injury
Co-Pay A copayment (or “copay”) is a monetary charge that your health insurance plan may require you to pay in order to receive a specific medical service or supply
Co-Insurance Co-Insurance is a percentage of the cost for a health service or prescription drug paid by a member after they have reached their deductible
Co-Insurance after deductible A type of insurance in which the insured pays a share of the payment made against a claim
Dental Insurance Dental insurance is meant to cover some of the costs associated with your dental care. Routine dental care, like regular checkups and cleanings.
Dental Plans Dental plans cover 100% of preventive care such as annual or semi-annual office visits for cleaning, X-rays and sealants. Basic procedures are treatment for gum disease, extractions, fillings, and root canals, with deductibles, co-pays and co-insurance determining the patient's out-of-pocket expenses
Deductible The deductible is the amount paid out of pocket by the policy holder before an insurance provider will pay any expenses.
In-Network Vs Out-of-Network Out of network simply means that the doctor or facility providing your care does not have a contract with your health insurance company. Conversely, in-network meansthat your provider has negotiated a contracted rate with your health insurance company.
Medical Vs Dental Insurance Medical insurance focuses more on covering consequences of injury and illness after they happen. And because medical care can be quite costly, medical coverage is designed to protect you from the burden of large expenses. Dental insurance is meant to cover some of the costs associated with your dental care. Routine dental care, like regular checkups and cleanings.
No Balance Billing Balance Billing. When a provider bills you for the difference between the provider's charge and the allowed amount. For example, if the provider's charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services.
Out of Pocket Exposure Out-of-pocket expenses refer to costs that individuals pay out of their own cash reserves