Being familiar with insurance terminology helps you better understand your dental benefits.
The date an individual and/or dependents become eligible for benefits under a dental benefits 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.
The person enrolled in a dental plan, including both the employee and dependents.
Dental services not covered under a dental benefit program.
Exclusive Provider Organization (EPO)
A dental benefits plan that provides benefits only if care is rendered by dentists with whom the plan contracts. Some exceptions are made for emergency and out-of-area services. The dentists have agreed to a discounted fee.
The date an individual ceases to be eligible for benefits.
Explanation of Benefits (EOB)
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 benefits plan.