The Substance Abuse and Mental Health Services Administration is a division of the United States Department of Health and Human Services that is a certifying laboratory agency.
Schedule of benefits
A listing of the services for which a benefit plan will pay is called the schedule of benefit
Seat belt benefit
If the insured dies from injuries sustained in an automobile accident while driving or riding in a private passenger car and wearing a seat belt, Humana Life will increase the amount of the insured's benefit by 10% (but not by less than $1,000 or more than $10,000).
Date the appliance is cemented/put in place is the seat date. For orthodontics, it is the date the bands are placed on the teeth.
Section 125 plan
This plan provides flexible benefits and qualifies under the IRS code to allow employee contributions with pre-tax dollars.
The specific county/ZIP code/state that a member actually resides in, the service area is where you must live for a plan to accept you as its member. If a member moves, he or she needs to contact Customer Care to see if the service area is affected.
Service area (Medicare)
The geographic area where a health plan accepts members is the service area. For Medicare plans that require you to use in-network doctors and hospitals, it is also the area where services are provided. The plan may disenroll you if you move out of the plan's service area.
Standard healthcare industry codes that doctors, hospitals, and other healthcare providers use to bill insurance companies for services. Next to each code is a shortened description to give you a general understanding of the service - for example, “office visit,” “lab work,” or “surgery.”
The date you received service from a healthcare provider. It is also referred to as the “date of service.”
Service start date
The date a particular service or procedure started.
Service stop date
The date a particular service or procedure ended.
Short-term disability insurance
A policy that pays benefits for a limited period of time (e.g., one year) is short-term disability insurance.
This is synthetic fillings other than silver, gold or ordinary cement used to set crowns, bridges, etc.
This is the type of healthcare provided by skilled nursing or rehabilitation staff members who are managing, observing, and evaluating your care.
Skilled nursing care
A level of care that must be given or supervised by Registered Nurses, skilled nursing care includes administering intravenous injections, tube feeding, giving oxygen, and changing sterile dressings on a wound. Any service that could be done safely by non-medical personnel without the supervision of a Registered Nurse is not considered skilled care.
These are cone-shaped cavities in the upper and lower arch, in which the teeth are embedded.
Special Enrollment Period (SEP)
During this set time period you can sign up for Medicare Part B if you did not take Part B during the Initial Enrollment Period because you had group health plan coverage through your or your spouse’s employer or union. You can enroll in Part B at any time while you are covered under the group plan. Once your existing employment or group coverage ends, you have eight months to enroll. The eight-month SEP starts the month after employment ends or the group health coverage ends, whichever comes first.
A doctor who treats only certain parts of the body, certain health problems, or certain age groups is a specialist. For example, some doctors treat only heart problems.
High-cost drugs, including high technology and self-administered injectable medications, are specialty drugs.
Specified Low-Income Medicare Beneficiaries (SLMB)
Specified SLMB is a Medicaid program that pays Medicare Part B premiums for individuals who have Medicare Part A, a low monthly income, and limited resources.
This appliance is used to prevent the motion of teeth.
Appliance to prevent motion of teeth.
Split enrollment refers to multiple family members enrolled in TRICARE Prime under different TRICARE regions or managed care support contractors.
The sponsor is the ADSM, retiree, or deceased service member or former service member through whom family members are eligible for TRICARE.
If your spouse is eligible for another employer's health plan — but chooses to be covered by your plan — you may pay a surcharge fee to cover some of your employer's costs for insuring your spouse.
Date on which the member's coverage begins or an account becomes available. Also called the “effective date.”
This informs you whether a policy is active, termed or COBRA.
This refers to an acrylic partial, with or without wire clasps, that replaces one or more teeth; usually temporary.
A term that refers to inflammation of the tissues of the mouth.
These plaster models of the teeth, made from an impression, show all the teeth in the upper and lower jaws and the relationship between the teeth.
The person who represents a family in a benefit program is a subscriber.
This is a unique identifying number for a dental insurance plan member.
Summary of benefits
This is a brief description or outline of your coverage, including the amounts or percentage you pay for certain services, the amounts or percentage your plan pays, and the services for which coverage is limited or excluded.
Summary Plan Description
This legal document details a member's or group's coverage.
Supplemental Health Care Program (SHCP)
SHCP is a program for eligible uniformed service members and other designated patients who require medical care that is not available at the MTF upon the approval of the cognizant MTF commander or the Director, TRICARE Management Activity, as required, to be purchased from civilian providers under TRICARE payment rules.
Generally, a supplier is any company, person, or agency that gives you a medical item or service, like a wheelchair or walker.
Removal of a tooth by surgical methods is a surgical extraction.