Glossary

A

Abutment:

A tooth or root that supports a fixed bridge or removable prosthesis.

Adjunctive General Services:

Important procedures that do not neatly fit into any of the other categories of services. Procedures within this category can include emergency palliative treatment, anesthesia, professional consultations, drugs or miscellaneous services such as bleaching.

Allowable Expense:

A monetary amount allowed according to your benefits plan.

Amalgam:

An alloy of mercury, silver and other metals, used as a restorative material.

Alternate Benefit:

A provision in a dental plan contract that allows payment of benefits based upon a less costly service when two or more dental treatments for a dental condition exist; provided that the less costly service would produce a professionally acceptable result under generally accepted dental standards; and would qualify as a covered service under the dental plan.

Anterior:

Refers to teeth located in front, cuspids or eyeteeth, and forward.

Arch:

The curved structure of the natural teeth. There are two arches in your mouth: the maxilla (maxillary) and the mandible (mandibular).

Adolescent Dentition:

Refers to the stage of permanent dentition prior to cessation of growth.

B

Benefit Paid:

The amount reimbursed to Payee as benefit for covered services.

Benefit Period:

The time defined by the dental benefit plan in regards to your benefits.

Bicuspid:

Most people have eight bicuspid teeth. They are located immediately preceding the molar teeth with two in each quadrant of the mouth.

Birthday Rule:

The Birthday Rule states that the plan of the parent whose birthday (excluding the year) is earlier in the year is primary for child. If both parents have the same date of birth (excluding the year), the plan with the earlier effective date is primary. MetLife adopted the NAIC (National Association of Insurance Commissioners) Birthday Rule approach to coordination of benefits for all cases on January 1, 1987. The Birthday Rule is gender-neutral, non-discriminatory and nationally uniform. All states have now also adopted this rule.

Bitewing:

A type of x-ray, where the patient bites on a special holder with dental film. This type of x-ray discloses cavities between the teeth and the levels of the bone.

Bleaching:

The cosmetic procedure of tooth whitening.

Bonded Teeth:

Teeth that have been restored with composite or resin fillings.

Bridge:

A replacement for one or more missing teeth that is permanently attached to the teeth adjacent to the empty space(s).Bruxism:A clenching or grinding of teeth with forceful jaw movements. This usually occurs during sleep.

Bonded Teeth: 

Teeth that have been restored with composite or resin fillings.

Bridge:

A replacement for one or more missing teeth that is permanently attached to the teeth adjacent to the empty space(s).

Bruxism:

A clenching or grinding of teeth with forceful jaw movements. This usually occurs during sleep.

C

Calculus:

Tartar (hardened dental plaque).Caries:Decomposed tooth structure also known as decay or cavities.

Cast High Noble Metal Crown:

A crown restoration that is fabricated by means of being cast using precious or semi-precious metal, usually gold.

Cavities:

Decomposed tooth structure also known as decay or dental caries.Claim Year:The year in which the listed dental services took place.

Co-insurance:

The percentage amount of a covered dental expense that you are responsible for after your deductible is met.

Composite:

A plastic restorative material; also called a resin.

Coordination of Benefits (COB):

This provision outlines how a plan will pay benefits when a patient is covered by more than one dental benefits plan.

Co-payment (DHMO):

Refers to the amount in the Schedule of Benefits for covered services that the participant is required to pay at the time of treatment.

Covered Expenses:

The maximum allowable amount that your plan will consider for services.

Credentialing:

This is the process used to select and retain dentists for the MetLife PPO and DHMO networks. Following the review of information on the application form that is submitted by a dentist, the state license, Drug Enforcement Agency Certificate and malpractice coverage are verified.

Crown:

The anatomical portion of the tooth above the gumline; restoration that replaces the entire tooth above the gumline, sometimes called a cap.

Crown Repair:

The repair of an existing crown which is usually the replacement of fractured porcelain.

D

Date of Service:

The date(s) service(s) or procedures took place.

Decay:

Decomposed tooth structure also known as dental caries or cavities.

Deductible Applied:

The amount you must pay before benefit payments will be made by the plan during each benefit period. Family deductibles are typically a multiple of an individual deductible. Deductibles may be waived for certain types of services (such as preventive care).

Dental Health Maintenance Organization (DHMO):

This type of plan provides in-network benefits only. Enrolled members pre-select a primary care dentist from the Find a Dentist directory and visit that dentist for all dental services. There are typically no calendar year maximums, deductibles, waiting periods, or claim forms. Patient co-payment is required for certain procedures.

Dental Preferred Provider Organization (DPPO):

The dental benefits program featuring the MetLife Preferred Dentist Program. Dentists participating in the program agree to accept negotiated fees as payment in full for covered services rendered to plan participants. MetLife's negotiated fees with participating dentists may extend to services not covered under the plan and services received after the plan maximum has been met, where permitted by applicable state law.

Dentition:

The teeth in the dental arch.Deciduous (Primary) Dentition:Refers to the deciduous or primary teeth in the dental arch.

Denture:A removable prosthesis replacing missing teeth.

Dependent:A spouse and/or child covered under your dental benefits plan. Dependent eligibility and coverage vary by plan.

Diagnostic:

Procedures necessary to recognize and identify any condition (and its causes) that may be a departure from normal. Diagnostic procedures provide your dentist with the information needed to determine the appropriate care for you, and may include exams, x-rays, tests or photographs.

E

Effective date
This is the date that marks the beginning of your coverage, once you enroll.

Eligibility
Meeting the necessary requirements for coverage. For State of Tennessee, this is defined as all employees working not less than 30 hours/week; seasonal employees hired prior to July 1, 2015 with 24 months of service and certified by their appointing authority to work at least 1,450 hours per fiscal year (July-June); or deemed eligible by applicable federal law, state law, or action of the State Insurance Committee.

Elimination Period
The period of disability during which MetLife does not pay benefits. The elimination period begins on the date of disability and continues for the period of time outlined in the plan in which the member is enrolled.

Evidence of Insurability
An application process in which you provide information on the condition of your health in order to be considered for certain types of insurance coverage.

Exclusions
An item or risk specifically not covered by an insurance policy. These include suicide, act of war, participation in a riot, commission of a felony, cosmetic or elective surgery. Please see the Certificate of Insurance for details.

F

Fee:

The amount charged by the dentist for each procedure.

File Reference Number:

The number assigned to identify each specific claim.

Fissures:

A groove or defect in the surface of a tooth.

Fixed Bridge:

The replacement of a missing tooth or teeth with a combination of abutments and pontics.Abutments go on existing teeth on either side of the missing tooth. Pontics replace the missing teeth. These are permanently cemented in the mouth and are removable only by a dentist.

Flap Entry and Closure:

A step within surgical procedures to open the gums and close, usually with sutures.

Fluoride:

Is used to prevent dental cavities. Fluoride may be in a liquid, paste, foam or tablet form. Fluoride treatment is more commonly provided to children because their enamel is more porous than adults and more susceptible to absorbing the fluoride. Fluoride aids in hardening the enamel and building up immunity to cavities. Fluoride may, in certain areas, be provided through community drinking water.

Forceps:

Special tools or instruments used in oral surgery procedures or extractions.

Full-Mouth X-ray/ Panorex X-ray:

X-rays of a patient's full mouth, as either individual x-rays (full mouth series) or one film (panoramic or Panorex).

G

General Anesthesia:

Renders a patient unconscious while the doctor supports their respiratory and other life-sustaining functions during and after treatment.

H

Health Insurance Portability and Accountability Act (HIPAA):

HIPAA is a federal law that was passed in 1996. The privacy rules and security rules of HIPAA set national standards for protection, security, and privacy of personal health information. Learn more about MetLife's privacy policies.

High Noble Metal:

The metals used in fabrication of restorations that are comprised of precious or semi-precious metals, usually gold.

I

Impacted Tooth:

A tooth that is below the gum tissue, bone or both.

Implant Services:

Completed to replace missing teeth with artificial components that function as natural teeth. Implants require at minimum two phases, surgical and restorative. Your regular dentist may place the implants or he/she may refer you to a specialist (Periodontist or Oral Surgeon).

Incisal:

Refers to the cutting edge of anterior teeth.

Inlay:

A cast restoration made to fit a prepared cavity and then cemented in place.

In-network:

Refers to oral health providers and facilities who participate in a MetLife network and the services that network provides.

Intraoral:

Within the oral cavity or mouth.

L

Lifetime:

The time defined by the life of your dental plan. It usually ends upon termination, changing of plan, or death.

Limitations:

The conditions stated in a dental benefit contract, such as age, frequency limitation, length of time covered, and waiting periods, that affect an individual's or group's coverage. The contract may also exclude certain benefits or services, or it may limit the extent or conditions under which certain services are provided.

M

Managed Dental Plan:

This type of benefits plan provides in-network benefits only. Enrolled members pre-select a primary care dentist from the ‘Find a Dentist’ directory and visit that dentist for all dental services. There are typically no annual maximums, deductibles, waiting periods or claim forms. Patient co-payment is required for certain procedures.

Mandibular:

Refers to the lower jaw.

Maxillary:

Refers to the upper jaw.

Member:

An individual enrolled in the dental plan.

Metallic:

Relating to, or having characteristics of, a metal; containing metal.

Met-to-Date:

The monetary amount of your deductible that has been paid to date defined by your coverage period.

Mucosa:

Refers to the soft tissues of the mouth.

N

Negotiated/ Network Fee:

The negotiated fee that participating dentists in your area have agreed to accept as payment-in-full for covered services. Your out-of-pocket costs should never be more than the difference between this amount and the plan benefit for all covered services. If you receive services from a participating dentist that are not covered under your plan or that occur after the maximum has been met, in states where permitted by law, you may only be responsible for the negotiated fee.

Non-participating Provider:

A dentist who does not participate in the MetLife Preferred Dentist Program and/or the Dental HMO/ Managed Care network.

L

Lifetime:

The time defined by the life of your dental plan. It usually ends upon termination, changing of plan, or death.

Limitations:

The conditions stated in a dental benefit contract, such as age, frequency limitation, length of time covered, and waiting periods, that affect an individual's or group's coverage. The contract may also exclude certain benefits or services, or it may limit the extent or conditions under which certain services are provided.