Glossary

Natural person considered for the purposes of the Insurance Policy, interchangeably, as the Insured Holder or Economic Dependent.

The insured is the person who meets the requirements set out in the Insurance Policy to receive dental services.

A natural person residing in the territory of the Mexican Republic, who has been designated as such in the Cover Page of the Insurance Policy, and who, when so established in the Insurance Policy, is responsible for the obligation to pay the Co-payment, Deductible or any other expense, in order to be able to receive dental or vision care for his Economic Dependents and himself.

Treatments or procedures covered by the dental plan contracted and specified in the Insurance Policy.

Document containing the information and data corresponding to: (i) the Insured or the Insureds, (ii) the Premium, (iii) the Co-payment, (iv) the validity of the coverage, (v) the limits of the coverage, and (vi) any other information regarding the terms under which the Insurance Policy must operate.

Codes of terminology relating to dental procedures.

Any group of people belonging to the same company or who maintain a common link or interest that is lawful, prior and independent to the execution of the Insurance Policy.

It is the natural or legal person representing the Insureds for the purposes of the Insurance Policy and the Endorsements, who enters into the Insurance Contract with Auna Seguros on his own behalf or on behalf of the Insureds, and who is directly responsible to Auna Seguros for the payment of the Premium.

A fixed amount that the insured must pay the dentist, calculated as a percentage of the maximum fees for each covered procedure. This percentage is indicated on the Policy Schedule and the Individual Certificate.

It is the amount that the Insured must pay for expenses, provided that he or his Economic Dependents receive any of the services considered as Covered Benefits under the Insurance Contract.

Dentist who has entered into a professional services agreement with Auna Seguros, and who is authorized to carry out Treatments for the Insured.

It is the right that the Insured acquires upon meeting all the necessary requirements to receive the benefits covered in the Insurance Contract.

This is the period under which Auna Seguros will cover the Dental Benefits contracted in the Insurance Policy and may be different for each insured person.

Document that modifies the Insurance Policy.

AbrasionTooth wear caused by forces other than chewing, such as: holding objects between the teeth or by improper brushing.SocketThe fossa in the alveolar bone that houses the root of the tooth.Dry AlveolusLocalized inflammation of the tooth socket after an extraction caused by infection or loss of the blood clot; osteitis.Temporomandibular jointThe hinge connecting mechanism between the base of the skull (temporal bone) and the lower jaw (mandible).WearThe normal deterioration of the tooth surface, resulting from chewing.Impacted ToothAn unerupted or partially erupted tooth that is lodged against another tooth, bone, or soft tissue in such a way that it is unlikely to fully erupt.Teeth whiteningA technique through which the color of a very stained tooth is whitened.Adhesive restorationA technique for bonding a filling or filling material to a tooth. Adhesive materials can be used to repair chipped, broken, warped, or discolored teeth, or to fill a gap between teeth.BruxismGrinding or clenching the teeth involuntarily.CariesDeterioration of the structure of a tooth caused by bacteria.ErosionWear and tear of the tooth structure caused by chemical substances (acids).RashWhen a tooth emerges or appears through the gum.ExtractionThe process or act of removing or extracting a tooth or parts of a tooth.CoatingA plastic or porcelain covering placed on the front surface of the tooth or crown to achieve a natural appearance.Traumatized toothA tooth below the gum tissue that lies over another tooth, below the bone or soft tissue, and is unlikely to grow on its own.Laminated veneerA thin layer of plastic or porcelain used to cover a front tooth to restore, strengthen, or improve its appearance.Dental PlaqueA bacterial substance that accumulates on the surface of the tooth. Plaque can cause cavities and gum irritation when it is not removed through daily brushing and flossing or professional cleaning.Dental ProphylaxisA professional cleaning to remove dental plaque, tartar (mineralized plaque) and stains in order to help cure or prevent dental disease.Mouthguard or guardA device that is placed over the teeth to prevent injuries to the teeth, mouth or lips, or to prevent teeth grinding or to treat temporomandibular disorders.RootThe anatomical part of the tooth that is covered by cementum and is located in the dental alveolus.

Replacement of missing or damaged teeth with artificial material.AmalgamA silver-colored alloy used to restore (fill) a tooth. Amalgam, used for over a century, has proven to be a safe, inexpensive, and durable material.Restoration with moldA procedure that uses a model of the tooth (an impression) to create a replacement tooth. Example: a crown.Anatomical CrownPortion of the tooth covered by enamel (visible outside the gum line)artificial crownAn artificial covering for a tooth made of metal, porcelain, or a porcelain-metal alloy. Crowns cover teeth weakened by decay or severely damaged or chipped.Inlay/OnlayA restoration, such as an inlay, is a mold made outside the mouth to fit the prepared cavity in the tooth and is cemented in place. An onlay replaces one or more dental cusps.Obturation (filling, plug, filling)Common terms used to describe the restoration of lost tooth structure with materials such as: metals, alloys, plastics, or porcelain.Resin/compositeTooth-colored filling material used primarily in front teeth. While cosmetically superior, it is generally less durable than other materials.

Private and personal communication between the Insured and the dentist so that the latter can diagnose the former's state of health, based on the symptoms and signs presented, as well as to prescribe the Treatment, perform the necessary Procedures, and, where appropriate, follow up on them.

A standard form that provides a detailed statement submitted by a dentist requesting payment for treatments or procedures under covered dental benefits. Dentists in the Auna Seguros network always submit claim forms for the insured patients they treat and accept payment directly from Auna Seguros so patients don't have to pay upfront and wait for reimbursement; they only pay the applicable deductibles and co-payments according to their dental plan. Claim forms are also used to request a pre-treatment estimate (cost predetermination).

Expenses and costs that Auna Seguros will cover directly or through reimbursement in favor of the Insured for the Treatments or Procedures covered in the contracted Plan.

This is the maximum amount that Auna Seguros will pay the dentist for fees, for each Procedure or Treatment performed by the dentist for Eligible Insureds, according to the contracted plan.

It is the maximum amount that Auna Seguros will pay for Covered Benefits in each year of validity of the Insurance Policy to each of the Insured, in accordance with the contracted Plan.

The amount per procedure or treatment that a dentist or insured person requests Auna Seguros to reimburse.

Payment system through which Auna Seguros directly settles with the dentist the expenses generated by the Insured, as a result of a Treatment or Procedure covered by the Insurance Policy.

Series of treatments diagnosed by the dentist to prevent or restore the oral health of the insured.

These are plans in which the Contractor's contribution to the payment of the Insured's Premium is less than 100% (one hundred percent) of the Premium.

These are plans in which the contribution of the policyholder to the payment of the premium of the insured is equal to 100% (one hundred percent) of the premium.

Document containing the terms and conditions of the Insurance Contract entered into between the Contractor or Insured and Auna Seguros.

Procedure by which an Insured, either by himself or through his dentist, can request a detailed estimate of the costs of a Treatment Plan indicated by the dentist, before the Treatment is carried out.

It is the set of Covered Benefits included in a dental insurance policy.

These are plans in which the Contractor's contribution to the payment of the Insured's Premium is equal to 100% (one hundred percent) of the Premium.

Price of dental insurance to be paid by the Policyholder.

Insurance Contract modality in which the Insured has the option of going to the dentist of their choice, regardless of whether it is a Dentist of the Auna Seguros Network or not; understanding, however, that, if the Insured goes to a dentist not affiliated with the Auna Seguros Network, the payment made for the claim will be made through the Reimbursement system.

Type of Insurance Contract in which the Insured only has to go to Dentists in the Auna Seguros Network.

Payment system according to which Auna Seguros reimburses the policyholder for covered expenses paid to cover a treatment provided for in the insurance policy if the policyholder goes to a dentist outside the Auna Seguros network.

The insurance contract is the means by which the insurer undertakes, through the collection of a premium, to compensate for damage or to pay a sum of money when the eventuality foreseen in the contract is verified.

Set of means used for the prevention, cure and relief of oral diseases and/or injuries of the Insured caused by an accident or illness.

That extraordinary situation that involves a physical ailment that urgently requires the immediate attention of the dentist to prevent physical damage or alleviate an ailment.