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.

G

Guaranteed Issue
A period of time when insurance coverage is offered to eligible employees without having to answer health questions.

L

Limitations
A restriction placed on certain situations, such as a disability due to mental, nervous conditions or substance abuse. Please see Certificate for details.

Long-Term Disability Insurance (LTD)
An insurance product that replaces a portion of the insured's income during an extended period of a disabling illness or accident.

M

Maximum Monthly Benefit (LTD)

The upper-end limit of how much LTD will pay out. For example, if you enrolled in LTD Option 3 and if you earned $17,000 per month ($204,000 per year) before your accident or illness and file a claim for LTD: 63% of $17,000 is $10,710. Since there is a maximum benefit of $10,000 per month, LTD insurance will only pay out $10,000 per month.

Maximum Weekly Benefit (STD))
The upper-end limit of how much STD will pay out. For example, if you enrolled in STD Insurance and if you earned $4,500 per week ($234,000 per year) before your accident or illness, and file a claim for STD: 60% of $4,500 is $2,700. Since there is a maximum benefit of $2,500 per week, STD insurance will only pay out $2,500 per week.

Minimum Monthly Benefit (LTD)
The lower-end limit of how much LTD will pay out under certain circumstances. The minimum is the greater of 10% of benefit or $100 per month. The minimum benefit will not apply if you receiving 100% of your pre-disability salary under the Policyholder (the State’s) paid leave policy

Minimum Weekly Benefit (STD)
The lower-end limit of how much STD will pay out under certain circumstances. The minimum STD benefit is $25 per week. The minimum benefit will not apply if you receiving 100% of your pre-disability salary under the Policyholder (the State’s) paid leave policy.

O

Own Occupation
The essential functions a member regularly performs that provide their primary source of earned income.

P

Pre-Existing Condition
A medical condition that started before a person's disability insurance went into effect.

Premium
What you would pay for disability insurance if you enroll. Premiums for the State of Tennessee plans are calculated monthly. Please refer to the “Rates” tab at the top of this page to calculate premiums.

S

Short-Term Disability Insurance (STD)
An insurance product that replaces a portion of the insured's income during the initial weeks of a disabling illness or accident.