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 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.
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
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-MISC47
06-21
Definitions Active Service You will be considered in Active Service:
HCDFB-DFS396
06-21
• 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.
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
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
myCigna.com
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