The following are definitions of words that have special or technical meanings under the AARP® Dental Insurance Plan, administered by Delta Dental Insurance Company.
A localized infection formed at the apex of the root tip.
A tooth, a root, or an implant used for the retention of a fixed or removable prosthesis.
For covered services, the allowed amount under the AARP Dental Insurance Plan, administered by Delta Dental Insurance Company 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.
Material used to fill cavities in teeth. Dental amalgam is a mixture of silver, mercury and other metals.
The cumulative total amount members must pay toward treatment before their health care benefits are paid in a calendar year. Also called a deductible.
The most the AARP Dental Insurance Plan, administered by Delta Dental Insurance Company will pay toward dental care within a calendar year. Also called the maximum benefit.
The teeth toward the front of the mouth, which include the incisors and cuspids.
The anatomic area at the end of the tooth root.
The surgical removal of the apical portion of the tooth through a surgical opening made in the overlying bone and gingival tissues. This procedure is often performed when an infection develops or persists after a root canal treatment.
The process by which Delta Dental determines whether a procedure or treatment is a referable benefit under the member’s plan.
benefit waiting period
The 12-month period of continuous enrollment that a member must complete before certain dental procedures become covered benefits.
Dental services provided under the terms of the contract as specified in the description of benefits and copayments.
The teeth with two rounded points located between the cuspids and molars; also known as premolars.
A technique to lighten the color of heavily stained teeth. Considered a cosmetic procedure.
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.
Non-removable artificial teeth attached to adjoining natural teeth when one or a few teeth are missing.
Involuntary clenching or grinding of the teeth, often during sleep.
The period beginning on Jan.1 and ending on Dec. 31.
Tooth decay. Also known as cavities.
A procedure that uses a model of the tooth to cast a restoration such as a crown, inlay or onlay to replace lost tooth structure.
The four front teeth. The centrals are the two upper and two lower teeth in the center of the mouth. The laterals are the teeth adjacent to the centrals.
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.
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.
A dentist who has a contract with Delta Dental; also known as a participating or network dentist.
AARP Dental Insurance Trust.
The amount charged to a member by a contract dentist for the benefits provided under this program.
An artificial tooth-shaped covering made of metal, porcelain or porcelain fused to metal, used to restore teeth that have weakened from decay, are severely damaged or chipped.
The pointed or rounded part of a tooth’s biting surface.
The teeth near the front of the mouth that come to a single point. Also known as eye teeth or canines.
Primary or baby teeth.
DeltaCare USA dentist
A dentist who is a member of the DeltaCare USA network.
Delta Dental dentist
A dentist who is a member of the Delta Dental PPO and Delta Dental Premier networks.
A duly licensed dentist legally entitled to practice dentistry at the time and in the state or jurisdiction in which services are performed.
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.
A member’s live-in, adult partner. Domestic partners can be the opposite sex or same sex as the member. Some state laws affect allowable coverage. Other terms used are legally domiciled adults and legally domiciled members.
The date a dental benefits contract becomes active (effective). Also, the date a member becomes eligible for benefits.
Any of the dependents of a member who are eligible to enroll for benefits and who meet the conditions of eligibility as described under eligibility for benefits.
Any AARP member who has been assigned an AARP membership number and who meets the conditions of eligibility as described under eligibility for benefits.
Dental services that are immediately required to relieve pain, swelling or bleeding, or are required to avoid jeopardizing the patient’s health.
Dental services that involve treatment of diseases or injuries that affect the root tip or nerve of the tooth. These services are not covered under the AARP Dental Insurance Plan, administered by Delta Dental Insurance Company.
Explanation of Benefits (EOB)
The notice that members and dentists receive after services have been provided and a claim processed. The EOB provides information about the fees charged, what procedures were provided, any adjustments made by the carrier and the member’s coinsurance payment.
A student who is regularly attending an accredited school with an academic schedule of at least 12 credits.
An inflammation of the gums surrounding the teeth caused by a buildup of plaque or food particles.
A tooth blocked from coming up through the gums by another tooth, bone or soft tissue.
A support used to replace a natural tooth and root or to support a bridge or denture that is surgically anchored into the jawbone.
The eligible member (primary member).
A filling cast to fit the missing portion of the top edges of a tooth and cemented into place.
A thin plastic or porcelain shell applied to the front of a tooth to restore, strengthen, or improve its appearance.
maximum contract allowance
The amount on which Delta Dental bases its payment. Depending on the specific group contract provision, the allowance may be the same as the accepted fee, a PPO fee, a table of allowance fee or some other amount.
An eligible member (primary member) or an eligible dependent (dependent member) enrolled to receive benefits.
A collective expression for all Delta Dental dentists who have contracted with Delta Dental to offer services to members and who have agreed to abide by certain administrative guidelines. There are two Delta Dental networks: Delta Dental PPO and Delta Dental Premier. Under the AARP Dental Insurance Plan, administered by Delta Dental Insurance Company, visiting a PPO network dentist generally results in the lowest out-of-pocket costs.
Non-Delta Dental dentist
A dentist who does not contract with Delta Dental and who is not contractually bound to abide by Delta Dental’s administrative guidelines.
An out-of-network dentist is a dentist who does not have a network contract with Delta Dental. For a given plan, an out-of-network dentist refers to a dentist who is not bound by a Delta Dental contract to follow specific fee requirements when treating patients covered under applicable plans.
A member exercises prudent judgment in determining that a dental emergency exists and makes at least one attempt to contact their contract dentist to obtain emergency services and, if 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 a member’s ability to obtain benefits. Examples include the inability to obtain access to the assigned contract dentist’s facility because of a physical disability and the inability to comply with the contract dentist’s instructions during examination or treatment because of physical disability or mental incapacity.
Services performed by a dental specialist, such as oral surgery, endodontics, periodontics, or pediatric dentistry. For certain plans, specialist services must be preauthorized in writing by Delta Dental.
A partner of the primary member by marriage, civil partnership or domestic partnership. To receive treatment, the person may have defined as a spouse by the laws of the state where the contract is issued and delivered or where the primary member resides.
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Delta Dental or the administrator, as appropriate.