Contracted Fee The term Contracted Fee means the total compensation level that a provider has agreed to accept as payment for dental procedures and services performed on You or Your Dependent, according to Your dental benefit plan.
Calendar Year Maximum This is the most We will pay for dental care within a Calendar Year. Once You reach the maximum amount, You will be responsible for paying any costs for the remainder of the benefit period.
HCDFB-DFS408
06-21
HCDFB-DFS396
06-21
Covered Dental Expenses The term Covered Dental Expenses means that portion of a Dentist’s charge that is payable for a service delivered to a Covered Person provided: • It is Medically Necessary and/or Dentally Necessary; • Provided by or under the direction of a Dentist or other appropriate provider as specifically described; • Your Deductible, if any, has been met; • The maximum benefit in The Schedule has not been exceeded; • The charge does not exceed the amount allowed under the Alternate Benefit Provision; and • It is not excluded as described in the section entitled General Limitations and Expenses Not Covered.
Certificate The term Certificate means this document, including any riders and attachments hereto, which sets forth Your benefits under the plan.
HCDFB-DFS403
01-19
Chewing Injury The term Chewing Injury means an injury which occurs during the act of chewing or biting. The injury may be caused by biting on a foreign object not expected to be a normal constituent of food; by parafunctional (i.e., abnormal) habits such as chewing on eyeglass frames or pencils; or biting down on a suddenly dislodged or loose dental prosthesis.
HCDFB-DFS409
06-21
HCDFB-DFS404
01-18
Covered Dental Service The term Covered Dental Service means a dental service used to treat a Covered Person’s dental condition and which is: • prescribed or performed by a Dentist while the insurance provided under this Certificate is in effect; • Medically Necessary and/or Dentally Necessary to treat the Covered Person’s condition; and • described in this Certificate.
Coinsurance The term Coinsurance means the percentage of charges for Covered Dental Expenses that a Covered Person is required to pay under the plan.
HCDFB-DFS405
06-21
Contract The Contract will be made up of the Policy; the Certificate; the application of the Policyholder, a copy of which is attached to the Policy; any riders and amendments to the Policy or Certificate; and any enrollment forms.
HCDFB-DFS410
06-21
Covered Person The term Covered Person means a person who is insured for dental coverage under the terms of the Policy and this Certificate.
HCDFB-DFS406
06-21
HCDFB-DFS411
01-18
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