Home Print a Section
Important Terms
As you read this summary of the JPMorgan Chase Dental Plan, you'll come across some important terms related to the plan. To help you better understand the plan, many of those important terms are defined here.
Term
Definition
Abutment
A tooth or root that retains or supports a bridge, or removable prosthesis.
Before-Tax Contributions
Contributions that are taken from your pay before federal (and, in most cases, state and local) taxes are withheld. Before-tax dollars are also generally taken from your pay before Social Security taxes are withheld. This lowers your taxable income and your income tax liability. This reduction to taxable income will not affect any other pay-related benefits, such as basic life insurance, long-term disability insurance, and your Retirement Plan benefits. So, your other benefits will continue to be based on your full, unreduced benefits pay.
Keep in mind that before-tax contributions do not count as earnings for Social Security purposes. Therefore, your future Social Security benefit could be slightly reduced if your total earnings for the year are less than the Social Security wage base ($102,000 for 2008). However, this reduction is nominal and may be outweighed by the immediate tax savings resulting from using before-tax dollars to pay for your benefits.
Bitewing
Dental X-ray showing approximately the coronal (crown) halves of the upper and lower teeth.
Bridge
A prosthesis restoring the continuity of the dental arch by replacing one or more artificial teeth suspended between — and attached to — abutments that provide support and stability.
Claims Administrator
The company that provides certain claims administration services for the Dental Plan.
Coinsurance
The way you share costs for certain coverage options after you meet the annual or lifetime deductible. Certain Dental Plan options pay either a percentage of reasonable and customary (R&C) charges or a percentage of the in-network dentist's negotiated fees for covered services, and you pay the remainder. The actual percentage depends on the option you've chosen and the type of covered service.
Consolidated Omnibus Budget Reconciliation Act of 1985 as amended (COBRA)
A federal law that allows you and/or your covered dependents to continue Dental Plan coverage on an after-tax basis (under certain circumstances) when coverage would otherwise have ended. The "Plan Administration" section of this Guide provides details on COBRA coverage.
Coordination of Benefits
The rules that determine how benefits are paid when a patient is covered by more than one group plan. Rules include:
  • Which plan assumes primary liability;
  • The obligations of the secondary claims administrator or claims payer; and
  • How the two plans ensure that the patient is not reimbursed for more than the actual charges incurred.
In general, the following coordination of benefits rules apply:
  • As a JPMorgan Chase employee, your JPMorgan Chase coverage is considered primary for you.
  • For your spouse/domestic partner or dependent child covered as a an active employee of another employer, that employer's coverage is considered primary for him or her.
  • For children covered as dependents under two plans, the primary plan is the plan of the parent whose birthday falls earlier in the year (based on month and day only, not year).
Specific rules may vary, depending on whether the patient is an employee in active status (or the dependent of an employee). These rules do not apply to any private insurance you may have. Please see "If You Are Covered by More Than One Dental Plan" for more details.
Copay or Copayment
The amount you pay toward certain covered services under the CIGNA DHMO Option. For example, the copayment for basic restorative services ranges from $0 to $250 and the copayment for major restorative services ranges from $15 to $325. The actual amount of the copayment will vary based on the procedure.
Covered Expenses
The reasonable and customary (R&C) charges for necessary covered services or supplies that qualify for full or partial reimbursement under the Dental Plan option.
Covered Services
Dental procedures that are generally reimbursable by the JPMorgan Chase Dental Plan when they are "necessary." (See the definition of "Necessary Services" in this section.) While the plan provides coverage for numerous services and supplies, there are limitations on what's covered. For example, a crown, bridge, or gold restoration is not covered if a tooth was prepared for it before the person became covered under the Dental Plan. So, while a service or supply may be necessary, it may not be covered under the JPMorgan Chase Dental Plan. Please see "What Is Covered" for more details.
Deductible
The amount you pay in a calendar year for covered expenses before the Preferred Dentist Program (PDP) Option or the Traditional Indemnity Option begins to pay benefits. Amounts in excess of reasonable and customary (R&C) charges do not count toward the deductible.
Denture
Artificial teeth replacing missing natural teeth.
Eligible Dependents
Under the Dental Plan, your eligible dependents can include your spouse or domestic partner, and your dependent children. Please see "Your Eligible Dependents" in the "Medical Plan" section of this Guide for more information.
Explanation of Benefits (EOB)
A statement that the claims administrator prepares, which documents your claim and provides a description of benefits paid and not paid under the Dental Plan.
Fully-Insured
Dental Plan options for which the benefit payments are the responsibility of the insurance carrier (DMO and DHMO).
In-Network/ Out-of-Network
Terms referring to whether a covered service is performed by a dentist who is part of the network associated with the Dental Plan ("in-network") or by a dentist who is not part of the network ("out-of-network"). When a service is performed in-network, benefits are generally paid at a higher level than they are when a service is performed out-of-network.
Maximum Annual Benefit
The most the Preferred Dentist Program (PDP) Option or the Traditional Indemnity Option (combined) will pay for covered preventive and restorative services for each participant in a year.
Maximum Lifetime Orthodontia Benefit
The most the Preferred Dentist Program (PDP) Option or the Traditional Indemnity Option (combined) will pay for covered orthodontia services for each participant's lifetime.
Any benefits that have been applied to a maximum provision under a dental plan of your heritage organization will also be applied to the lifetime maximum for this Dental Plan.
Missing Tooth Exclusion
An ineligible charge for a partial or full removable denture, removable bridge, or fixed bridgework if it includes replacement of one or more natural teeth missing before the person became covered under the Dental Plan. This exclusion does not apply if the denture, bridge, or bridgework also includes replacement of a natural tooth that:
  • Is removed while the person is covered; and
  • Was not an abutment to a partial denture, removable bridge, or fixed bridge installed during the prior five years.
Necessary Services
Services or supplies that are accepted and used by the dental community as appropriate for the condition being treated or diagnosed. The services or supplies also must be prescribed by a dentist for the diagnosis or treatment of the condition to be considered necessary. Some prescribed services may not be considered necessary and may not be covered under the JPMorgan Chase Dental Plan. The claims administrator or claims payer will determine whether a service or supply is necessary.
Finally, to be considered necessary, a service or supply cannot be cosmetic, educational or experimental in nature in terms of generally accepted dental standards.
Non-Duplication of Benefits
The Dental Plan does not allow for duplication of benefits. If you and your eligible dependents are covered under more than one group plan, the primary plan (the one responsible for paying benefits first) needs to be determined. You are entitled to receive benefits up to what you would have received under the Dental Plan if it were your only source of coverage, but not in excess of that amount. If you have other coverage that is primary to the Dental Plan, the claims administrator will reduce the amount of coverage that you would otherwise receive under this plan by any amount you receive from your primary coverage. Please see the definition of "Coordination of Benefits" in this section for more information.
Palliative
A service or treatment that reduces the harmful effects of a condition — usually an acute (emergency) situation.
Periodontal Disease
A condition that weakens and destroys the gum, bone, and membrane which surround and support the teeth, such as pyorrhea, gingivitis, or Vincent's disease.
Pre-Determination
An itemization of the proposed course of treatment (including recent pre-treatment X-rays), which you should submit before work is begun, if you anticipate that charges will be more than $300. A dental consultant will review the proposed treatment before work begins and the claims administrator will inform you and your dentist of the amount of covered charges. That way, you'll understand the benefits that will be paid before treatment begins. Benefits will be paid according to the plan provisions in effect when the services are actually rendered. The amount may change if the treatment changes from that which was predetermined or if frequency limits apply. Except in the case of an emergency, you may not want to begin the course of treatment until you know what amount your JPMorgan Chase Dental Plan option will pay.
Prophylaxis
Prevention of disease by removal of tartar, stains, and other extraneous materials from the teeth, or the cleaning of the teeth by a dentist or by a dental hygienist.
Prosthesis
In general, something that replaces a missing part of the body. The dental specialty dealing with replacement of teeth is called prosthodontics.
Qualified Change in Status
The JPMorgan Chase benefits you elect during each annual benefits enrollment period will generally stay in effect throughout the plan year, unless you elect otherwise due to a qualified change in status (such as marriage, divorce, the birth or adoption of a child, etc.) within 31 days of the event for benefits to be effective the date of the event. If you miss the 31-day deadline, coverage for certain benefits will be effective as of the date you contact the Benefits Call Center.
Please Note: Any changes you make during the year must be consistent with your qualified change in status. Please see "Qualified Change in Status" for more information.
Reasonable and Customary (R&C) Charges
The actual charges that are considered for payment when you receive medically necessary care for covered services under the Dental Plan. R&C means the prevailing charge for most providers in the same or a similar geographic area for the same or similar service or supply. These charges are subject to change at any time without notice. Reimbursement is based on the lower of this amount and the provider's actual charge.
If your provider charges more than the R&C charges considered under the plans, you'll have to pay the difference. Amounts that you pay in excess of the R&C charge are not considered eligible expenses. Therefore, they don't count toward your deductible, benefit limits, or maximums.
Self-Insured
How JPMorgan Chase pays for dental claims under the PDP and Traditional Indemnity Options.