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Insurance Dictionary

Being familiar with insurance terminology helps you better understand your dental benefits.


A process of gauging the performance of organizations against a set of agreed upon standards or measures.
An arrangement under which an administrator processes claims for a fee and handles paperwork for a self-funded group. The employer assumes the risk for claims submitted.
A person who manages or directs a dental benefits program on behalf of the program's sponsor. The administrator can include an insurance company, third party or employer.
The maximum dollar amount on which benefit payment is based for each dental procedure.
If more than one type of service can be used to treat a dental condition, the administrator has the right to base benefits on the least expensive service which is in the range of professionally accepted standards of dental practice.
The beginning of an employer's benefit year.
A procedure whereby a beneficiary/patient authorizes the administrator of the program to forward payment for covered procedure directly to the treating dentist.
An examination of records or accounts to check their accuracy. A post-treatment record review or clinical examination to verify information reported on claims.