Glossary of Terms

Third Party Administrator (TPA):

A TPA is a licensed business that helps employers provide their dental (or medical, HSA, flex, etc.) plan to their employees. Generally, the TPA provides the necessary administrative components of the plan such as: employee benefit booklets and ID cards; claims processing; transferring necessary funds to pay claims; providing explanations of benefits to employees and providers; and sending benefit reimbursement checks to the appropriate employee or dental office. The TPA also provides detailed reports which allow employers to monitor their plans.

TPA:

See Third Party Administrator (TPA)

Assignment of Benefits:

An employee can choose either to be reimbursed for the services received or elect to have the benefit "assigned" - meaning paid - directly to the dental office. Put simply, patients can choose which reimbursement method works best for them.

Pre-Estimate of Services:

A pre-estimate is a close approximation of what specific dental services through a specific dental office will cost an employee out of pocket. A pre-estimate is not a guarantee, but rather a good faith effort to provide patients with as much information as possible. Unlike some plans, MDB does not require pre-estimates. Note: Pre-estimates are sometimes incorrectly referred to as pre-authorizations. MDB does not authorize dental care or services; the patient provides authorization to the dental office to proceed.

Eligibility:

Each employer and dental plan can have its own eligibility requirements. Eligibility status depends on what benefits category the employee chooses. For example, an employee may choose coverage as a single dependent or for an entire family. The most common eligibility question received by MDB has to do with student eligibility. Most plans that offer family coverage usually terminate benefits for family members at age 19. Some plans continue benefits for eligible dependents beyond their 19th birthday. This requires some "proof" of eligibility, such as student's college tuition statement. When employers do offer this extended period of eligibility, it normally terminates, regardless of status, by age 23 or 25.