Being familiar with insurance terminology helps you better understand your dental benefits.
Open Enrollment
The annual period in which employees can select from a choice of benefits programs.
Out-of-Network
Services rendered by dentists other than those who have contracted to provide care through a network option (PPO, DHMO).
Out-of-Pocket Expenses
Any amount that the member is responsible for paying, such as deductibles, co-payments and costs exceeding the maximum.
Out-of-Pocket Maximums
An annual limit on how much money a member must pay before insurance begins to cover 100% of their dental care expenses.
Overbilling
Nondisclosure of waiver of patient co-payment.
Overcoding
Reporting a more complex and/or higher cost procedure than was actually performed.
