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.
• 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.
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
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.
HCDFB-DFS411
01-18
Deductible The term Deductible means expenses to be paid by You or Your Dependents before benefits are paid under the Policy.
HCDFB-DFS408
06-21
HCDFB-DFS412
01-18
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;
Dentist The term Dentist means a person practicing dentistry or oral surgery within the scope of the person’s license. It will also include a provider operating within the scope of the provider’s license when performing any of the Covered Dental Services described in the Policy.
HCDFB-DFS414
06-21
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