Glossary/Definition of Terms

The following are definitions of words that have special or technical meanings under the AARP® Dental Insurance Plan, administered by Delta Dental Insurance Company.

Delta Dental PPO Terms

Abscess
A localized infection formed at the apex of the root tip.
Abutment
A tooth, a root, or an implant used for the retention of a fixed or removable prosthesis. Also known as a retainer.
Allowed Amount
For covered services, the Allowed Amount under the AARP Dental Insurance Plan is the lesser of the dentist’s submitted fee or the PPO Maximum Allowance if the dentist is a Delta Dental PPO Dentist or a Non-Delta Dental Dentist. For Delta Dental Premier® contracting dentists, the Allowed Amount is the lesser of the dentist’s submitted fee, the PPO Maximum Allowance, or the Delta Dental Premier Maximum Allowance. For non-covered services, the Allowed Amount is zero.
Amalgam
Sometimes referred to as a silver filling. Used for more than a century, amalgam fillings are proven to be safe, cost-effective and durable.
Anterior Teeth
The teeth toward the front, which include the incisors and cuspids.
Apex
The anatomic area at the end of the tooth root.
Apicoectomy
The surgical removal of the apical portion of the tooth through a surgical opening made in the overlying bone and gingival tissues.
Attrition
The wearing down of the surface of a tooth from chewing or grinding teeth.
Benefits
Dental services available under the AARP Dental Insurance Plan, which are described in this booklet and are provided to an Enrollee by a licensed dentist.
Benefit Waiting Period
The 12-month period of time of continuous enrollment that an Enrollee must complete before certain dental procedures become covered benefits.
Bicuspids/Premolars
The teeth with two rounded points (cusps) located between the eye-teeth (cuspids) and the molars.
Bleaching
A technique that lightens the color of heavily stained teeth. Considered a cosmetic procedure.
Bonding
The technique to adhere a filling material to a tooth. Bonding materials may be used to repair chipped, cracked, misshapen or discolored teeth, or to fill in a gap between teeth.
Bridges
Non-removable artificial teeth attached to adjoining natural teeth when one or a few teeth are missing.
Bruxism
Involuntary clenching or grinding of the teeth.
Calendar Year
The time period beginning on January 1st and ending on December 31st.
Caries
Tooth decay, also known as a cavity.
Cast Restorations
A procedure that uses a model of the tooth (an impression) to make a metal casting which replaces missing parts. Example: A Crown.
Centrals/Laterals
The four front teeth. The centrals are the two upper and two lower teeth in the very center of your mouth. The laterals are the teeth just adjacent to the centrals.
Claim Form
A written or electronically submitted document to request payment for completed dental treatment or to request a pre-treatment estimate for proposed dental treatment. The claim form is also sometimes called an Attending Dentist's Statement.
Contract
The written agreement between Delta Dental Insurance Company and AARP Dental Insurance Trust to provide dental benefits. The Contract, together with this booklet, forms the terms and conditions of benefits available to you under the AARP Dental Insurance Plan.
Copayment
Your share of the cost of a given service, usually expressed as a percentage of the dentist's Allowed Amount.
Covered Services
See Benefits.
Crown/Jacket/Cap
The artificial covering of a tooth with metal, porcelain or porcelain fused to metal. Crowns cover teeth weakened by decay or severely damaged or chipped.
Cusp
The pointed or rounded part of a tooth's biting surface.
Cuspids
The teeth near the front of the mouth that come to a single point. Sometimes called the "eye teeth" or "canines."
Deciduous Teeth
Primary or baby teeth.
Deductible
The dollar amount Enrollees must pay toward completed treatment before Delta Dental payment is applied to those services in a Calendar Year.
Delta Dental Dentist
A dentist who contracts with Delta Dental and agrees to abide by certain administrative guidelines. Delta Dental Dentists include dentists who are members of the Delta Dental PPO and Delta Dental Premier networks.
Delta Dental PPO (PPO) Dentist
Dentist is a contracting dentist and is a member of the Delta Dental PPO national preferred provider organization plan that allows Enrollees to visit any licensed dentist, but offers incentives to choose a PPO network dentist.
Delta Dental Premier Dentist
Dentist who is a contracting dentist and is a member of the Delta Dental Premier Dentist network.
Delta Dental Premier Maximum Allowance
The maximum fee for a covered dental service payable by Delta Dental to a member of the Delta Dental Premier Dentist network.
Dentures
Removable artificial teeth in a plastic base that rests directly on the gums. A denture may be a complete or partial depending on the number of missing natural teeth.
Effective Date
The date your eligibility for covered services begins. For the AARP Dental Insurance Plan, this date will always be the first of the month.
Endodontics
Dental services that involve treatment of diseases or injuries that affect the root tip or nerve of the tooth.
Services that are not covered under the AARP Dental Insurance Plan.
Explanation of Benefits (EOB)
See Notice of Payment.
Gingivitis
An inflammation of the gums surrounding the teeth caused by a buildup of plaque or food particles.
Impacted Tooth
A tooth partially or fully beneath the gum tissue that is under bone or soft tissue and is unlikely to erupt (grow out) on its own.
Implant
A support for a bridge or denture that has been surgically placed into the bone.
Inlay
A solid laboratory-processed filling cast to fit the missing portion of the tooth and cemented into place. This type of restoration does not involve the high points (cusps) of the tooth.
Laminate Veneer
A thin plastic or porcelain shell applied to the front of a tooth to restore, strengthen or improve its appearance.
Limitations
The number of services allowed, frequency of services allowed, and the most affordable dentally appropriate service.
Malocclusion
Incorrect position of biting or chewing surfaces of the upper and lower teeth.
Maximum Benefit
The total maximum dollar amount the AARP Dental Insurance Plan will pay toward the cost of dental care incurred by an individual Enrollee in a Calendar Year.
Member
A person enrolled as a member of AARP and assigned an AARP membership number.
Molars
Teeth with broad chewing surface for grinding food, located in the back of the mouth.
Network
A collective expression for all Delta Dental Dentists who have contracted with Delta Dental to offer services to Enrollees and who have agreed to abide by certain administrative guidelines. There are two separate and distinct Delta Dental networks: Delta Dental PPO and Delta Dental Premier. Under the AARP Dental Insurance Plan, visiting a PPO network dentist generally results in the lowest out-of-pocket cost.
Non-Delta Dental Dentist
A dentist who does not contract with Delta Dental in either the Delta Dental Premier or Delta Dental PPO network and who is not contractually bound to abide by Delta Dental’s administrative guidelines.
Notice of Payment
The statement you receive after a claim is processed, detailing how your claim payment was calculated including the procedures and fees submitted and the amount for which you are responsible.
Occlusal
Pertaining to the biting surfaces of the premolar and molar teeth or contacting surfaces of opposing teeth. For example, the chewing surfaces of the back teeth.
Out-of-Pocket Costs
The portion of dental fees that you pay. Out-of-pocket costs include your deductible, copayment, any amount exceeding the Calendar Year Maximum Benefit amount, and optional services not covered by the AARP Dental Insurance Plan.
Overdenture
A removable denture that fits over a small number of remaining natural teeth or implants to provide better stability for the denture.
Pedodontist/Pediatric Dentist
A dental specialist who treats children from birth through adolescence.
Periapical
The area surrounding the end of a tooth root.
Periodontics
Services that involve treatment of diseases of the gums, tissue and bone that supports the teeth.
Periodontitis/Gum Disease
Chronic inflammation and destruction of supporting bone and tissue membrane around the roots of teeth.
Permanent Teeth
Adult Teeth.
Plaque
A bacteria-containing substance that collects on the surface of teeth. Plaque can cause decay and gum irritation when it is not removed by daily brushing and flossing.
Pontic
The portion of a dental bridge that replaces missing teeth.
Post and Core
An anchor placed in the tooth root following a root canal to strengthen the tooth and help hold a crown (cap) in place.
Posterior Teeth
The teeth toward the back of the mouth.
PPO Maximum Allowance
The maximum fee for a covered dental service payable by Delta Dental to a member of the Delta Dental PPO Dentist network.
Premier Maximum Allowance
The fee for each single procedure that a Premier Dentist has contractually agreed to accept as payment in full for treating Enrollees. This fee may be higher than the PPO Maximum Allowance, but is typically less than the amount charged by Non-Contracted Dentists.
Premiums
The money paid to Delta Dental for each month of dental coverage for the Primary Enrollee and the Primary Enrollee's enrolled family members. Payment may be submitted monthly (through EFT), quarterly, semi-annually, or annually.
Pre-treatment Estimate
A pre-treatment estimate gives a non-binding estimate of how much of a proposed treatment plan will be covered under an Enrollee's dental program and what the Enrollee's out-of-pocket cost will be.
Primary Enrollee
The AARP member who applies for enrollment in the AARP Dental Insurance Plan. At least one enrolled family member must be an active AARP member who will be designated as the Primary Enrollee.
Prophylaxis
A professional cleaning to remove plaque, calculus (mineralized plaque) and stains to help prevent dental disease.
Prosthodontics
Services involving replacement of missing teeth with artificial materials, such as a bridge or denture.
Pulp
The blood vessels and nerve tissue inside a tooth.
Resin/Composite
Tooth-colored filling material. Although cosmetically superior, it is less durable than other materials.
Restorations
Procedures involving the replacement of missing or damaged tooth structure with artificial materials.
Root Canal Treatment
The removal of the pulp tissue of a tooth due to decay, infection (abscess) or injury.
Root Planing
A treatment of periodontal disease that involves scraping the roots of a tooth and gums to remove bacteria and mineralized plaque (tartar) from the root surfaces and tooth pocket.
Sealant
A thin plastic material used to cover the biting surface of a child's tooth to prevent tooth decay.
Spouse
A person related to or a partner of the Primary Enrollee:
  • as defined and as may be required to be treated as a Spouse by the laws of the state where this Contract is issued and delivered;
  • as defined and as may be required to be treated as a Spouse by the laws of the state where the Primary Enrollee resides; and
  • domestic partner.
Submitted Amount
The amount the dental office actually submits on the claim form. This is the fee normally charged by the dentist for services provided to all patients, regardless of insurance coverage.

DeltaCare USA Terms

Authorization
The process by which Delta Dental determines if a procedure or treatment is a referable Benefit under the Enrollee’s plan.
Benefits
Those dental services which are provided under the terms of the Contract as specified in the Description of Benefits and Copayments.
Contract
The agreement between Delta Dental and Contractholder including the Application for the Contract, the attached schedules, and any appendices, endorsements, or riders. The Contract constitutes the entire agreement between the parties.
Contract Dentist
A DeltaCare USA Dentist who provides services in general dentistry and has agreed to provide Benefits to Enrollees under this Program.
Contractholder
AARP Dental Insurance Trust.
Contract Orthodontist
A DeltaCare USA Dentist who specializes in orthodontics and has agreed to provide Benefits to Enrollees under this Program.
Contract Specialist
A DeltaCare USA Dentist who provides Specialist Services and has agreed to provide Benefits to Enrollees under this Program.
Copayment
The amount charged to an Enrollee by a Contract Dentist for the Benefits provided under this Program.
Dentist
A duly licensed Dentist legally entitled to practice dentistry at the time and in the state or jurisdiction in which services are performed.
Domestic Partner
A person who, together with the Eligible Member, has affirmed a domestic partnership.
Effective Date
The first day of the month following Delta Dental's timely receipt of Premium and the enrollment form.
Eligible Dependent
Any of the dependents of an Eligible Member who are eligible to enroll for Benefits and who meet the conditions of eligibility as described under Eligibility for Benefits.
Eligible Member
Any AARP member who has been assigned an AARP membership number and who meets the conditions of eligibility as described under Eligibility for Benefits.
Emergency Service
Care provided by a Dentist to treat a dental condition which manifests as a symptom of sufficient severity, including severe pain, such that the absence of immediate attention could reasonably be expected by the Enrollee to result in either: 1) placing the Enrollee's dental health in serious jeopardy, or 2) serious impairment to dental functions.
Enrollee
An Eligible Member ("Primary Enrollee") or an Eligible Dependent ("Dependent Enrollee") enrolled to receive Benefits.
Full-Time Student
A Student who is regularly attending an accreditied school with an academic schedule of at least 12 credits.
Individual
The Eligible Member (“Primary Enrollee”).
Out-of-Network
Treatment by a Dentist who has not signed an agreement with Delta Dental to provide Benefits under the terms of this Contract.
Preauthorization
The process by which Delta Dental determines if a procedure or treatment is a referable Benefit under the Enrollee's plan.
Premium
The money paid by the Primary Enrollee to cover the Primary Enrollee and any Dependent Enrollee under this Program.
Primary Enrollee
The active AARP member who applies for enrollment in the DeltaCare USA Program for AARP Members.
Reasonable
An Enrollee exercises prudent judgment in determining that a dental emergency exists and makes at least one attempt to contact his/her Contract Dentist to obtain Emergency Services and, in the event the Dentist is not available, makes at least one attempt to contact Delta Dental for assistance before seeking care from another Dentist.
Special Health Care Need
A physical or mental impairment, limitation or condition that substantially interferes with an Enrollee's ability to obtain Benefits. Examples of such a Special Health Care Need are 1) the Enrollee's inability to obtain access to the assigned Contract Dentist's facility because of a physical disability and 2) the Enrollee's inability to comply with the Contract Dentist's instructions during examination or treatment because of physical disability or mental incapacity.
Specialist Services
Services performed by a Dentist who specializes in the practice of oral surgery, endodontics, periodontics, or pediatric dentistry and which must be preauthorized in writing by Delta Dental.
Spouse
A spouse by lawful marriage or a civil union partner. A civil union includes a relationship that provides substantially all of the rights and benefits of marriage and is valid under the laws of the jurisdiction in which the civil union relationship was entered.
We, Us and Our
Delta Dental or the Administrator, as appropriate.

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