Assignability The benefits under this Contract are not assignable unless agreed to by Us. We may, at Our option, make payment to the Employee for any cost of any Covered Dental Expense received by the Employee or Employee’s covered Dependents from a Non-Participating Provider. The Employee is responsible for reimbursing the Non-Participating Provider. Clerical Error No clerical error on the part of Us shall operate to defeat any of the rights, privileges or benefits of any Employee. Entire Contract The entire Contract will be made up of the Policy; the Certificate; the application of the Employer, a copy of which is attached to the Policy; any riders and amendments to the Any provision of this Certificate that is in conflict with the applicable statutes of the state whose law governs the Policy or this Certificate or with any applicable federal statute is amended to conform to the minimum requirements of such statutes. Statements not Warranties All statements made by the Employer or any person covered under the Certificate will, in the absence of fraud, be deemed representations and not warranties. No statement made by You or the Employer to obtain insurance will be used to avoid or reduce the insurance unless it is made in writing and signed by You or the Employer and a copy is sent to the Employer, You and/or Your beneficiary. Time Limit on Certain Defenses After two years from the Effective Date, no misstatements, except fraudulent misstatements, made by You in the application or any application amendment will be used to void this Certificate or to deny a claim for loss incurred after the expiration of such two-year period. No claim for loss Policy or Certificate; and any enrollment forms. Conformity with State and Federal Statutes commencing after 12 months from the Effective Date will be reduced or denied on the grounds that a disease or physical condition, not excluded from coverage by name or specific description, had existed prior to such Effective Date. Your Dental Records In order to provide benefits under this Certificate, process claims, make payments or review appeals and/or grievances, We may need to obtain information and records from Dentists who provided Your services or treatment. Your acceptance of coverage under the Policy gives Us permission to obtain, copy and use Your dental records and information for such purposes and authorizes Your Dentist to disclose information that
pertains to Your physical condition or the services or treatment You receive. We agree to maintain Your dental records and information in accordance with state and federal confidentiality requirements.
HCDFB-MISC47
06-21
Definitions Active Service You will be considered in Active Service:
• on any of Your Employer's scheduled work days if You are performing the regular duties of Your work on a Full-Time basis on that day either at Your Employer's place of business or at some location to which You are required to travel for Your Employer's business. • on a day which is not one of Your Employer's scheduled work days if You were in Active Service on the preceding scheduled work day.
HCDFB-DFS391
06-21
Amount Eligible for Coverage by Your Plan The term means, part of the “Amount Your Health Care Professional Charged” or “Your Health Care Professional’s Contracted Amount” (if present) that is eligible for coverage under Your plan. This amount is used to help calculate how much will be paid by Your plan.
HCDFB-DFS392
06-21
Balance Billing When a Dentist bills an enrollee for amounts above the Amount Eligible for Coverage by Your Plan, the Dentist may bill You for the difference. Non-participating Dentists are under no obligation to limit the amount of their fees.
HCDFB-DFS394
06-21
Calendar Year The term Calendar Year means the period that begins on January 1st and ends on December 31st of that year.
HCDFB-DFS395
06-21
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