<P>18© 2009 AAPD All rights reserved. Dental Insurance – Also known as pre-payment plans or third-party coverage, is a bene?t designed to cover a portion of the cost for dental care services. The employer or employee purchases coverage by paying a monthly premium. In turn, the insurer agrees to pay for some or all of the employees dental care, as per the agreement, up to a speci?c coverage limit. In many cases, the employer may have arrangements in place to directly pay the agreed portion to the employee. If employees need care exceeding this cap amount, they will be responsible for paying the balance. Eligibility Date – The date an individual and dependents become eligible for bene?ts under a dental bene?ts contract. The date is often referred to as the effective date. Fee-for-Service – A freedom of choice arrangement under which a dentist is paid for each service provided according to the full fees established by the dentist. Flexible Spending Account (FSA) – An employee reimbursement account primarily funded with employee-designated salary reductions. Funds are reimbursed to the employee for health care (medical and dental), dependent care, or legal expenses, and are considered a nontaxable bene?t. Freedom of Choice – The concept that a patient has the right to choose any licensed dentist to deliver his or her oral health care without any type of coercion. Managed Care – A type of dental plan that is a contractual agreement in which the payment, reimbursement or utilization is controlled by a third party. This concept represents a cost containment system that directs the utilization of health care by: a) restricting the type, level and frequency of treatment; b) limiting the access to care; c) controlling the level of reimbursement for services; and d) controlling referrals to other dentists. Preauthorization – A statement by a third-party payer indicating that proposed treatment is covered under the terms of the bene?t contract. Some plans require a dentist to submit a treatment plan to a third-party payer for approval before the treatment is started. Precerti?cation – Con?rmation by a third-party payer of a patients eligibility for coverage under a dental bene?t plan. Predetermination – A process used to determine the bene?ts available for dental services that are planned by the dentist: an estimate of the amount payable by the plan if services are rendered when the patient is eligible. Under some programs, predetermination by the third party is required when covered charges are expected to exceed a certain amount. </p> <UL><LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/1/1/">Front-Cover</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/2/2/">Inside-Front-Cover</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/3/3/">Page-3</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/4/4/">Page-4</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/5/5/">Page-5</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/6/6/">Page-6</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/7/7/">Page-7</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/8/8/">Page-8</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/9/9/">Page-9</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/10/10/">Page-10</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/11/11/">Page-11</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/12/12/">Page-12</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/13/13/">Page-13</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/14/14/">Page-14</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/15/15/">Page-15</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/16/16/">Page-16</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/17/17/">Page-17</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/18/18/">Page-18</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/19/19/">Page-19</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/20/20/">Back-Cover</a></LI> <LI><a href="http://www.stallionpublishers.com/publications/1603/x/sitemap.xml" target="_blank">site map</a></LI> </UL>

 

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