Accidental Dental

Accidental dental coverage pays for the repair or replacement of natural teeth damaged due to an accidental blow to the mouth or jaw. This benefit is distinct from routine dental coverage because it applies to emergencies caused by external physical impact, not decay or normal wear.

Accidental dental benefits often appear in health sections of a plan (as opposed to dental sections). They cover reasonable and necessary treatment, such as crowns, bridges, or repairs, up to a defined maximum per accident or per year. To qualify, treatment typically must begin within a set period (for example, 90 days of the accident).

Example:

If you fall and chip a tooth, your accidental dental benefit could pay for the repair, subject to plan limits and medical necessity.

What to Watch For:

Report the injury and seek treatment promptly, as delays can void eligibility. Confirm whether the limit applies per accident or per calendar year.

Related Terms

Accident

An accident is an unexpected, sudden, and external event that causes bodily injury, occurring independently of any illness or pre-existing condition. In the context of health and dental insurance, an accident typically refers to physical harm resulting from an unforeseen incident such as a fall, collision, or blow to the body. Accidents are distinct from sickness or degenerative conditions because they are caused by an identifiable event rather than a gradual process.

Accidental Death and Dismemberment Insurance (AD&D)

Accidental Death and Dismemberment Insurance (AD&D) provides a tax-free lump-sum payment if you die or suffer a severe injury as the direct result of an accident. It is designed to offer financial protection for you and your family in the event of an unexpected, accidental injury or loss that causes death, dismemberment, or permanent disability.

Actuary

An actuary is a professional who specializes in analyzing financial risk and uncertainty, particularly in the fields of insurance, pensions, and investments. Actuaries use mathematics, statistics, and financial theory to calculate premiums, reserves, and probabilities of future events such as illness, disability, or death. Their work ensures that insurance plans remain financially stable and that companies can meet future claim obligations while staying competitively priced.

Advisor/Agent

An advisor or agent is a licensed professional who helps individuals and businesses understand, choose, and manage insurance and financial products. In the context of health, dental, life, and disability insurance, an advisor’s role is to assess a client’s needs, explain plan options, and recommend solutions that provide appropriate protection within their budget.

Age Limit (Travel)

The Age Limit (Travel) refers to the maximum age at which a person is eligible for emergency medical travel insurance coverage or specific benefits under a health or dental plan. Insurers impose age limits to manage risk, as medical expenses tend to rise significantly with age and the likelihood of pre-existing conditions increases.

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