Emergency Services The term Emergency Services means a service required immediately to either alleviate pain or to treat the sudden onset of an acute dental condition. These are usually minor procedures performed in response to serious symptoms, which temporarily relieve significant pain, but do not effect a definitive cure, and which, if not rendered, will likely result in a more serious dental or medical complication.
A natural tooth means any tooth or part of a tooth that is organic and formed by the natural development for the body (i.e., not manufactured). Organic portions of a tooth include the crown enamel and dentin, the root cementum and dentin, and the enclosed pulp (nerve).
HCDFB-DFS431
06-21
Handicapping Malocclusion The term Handicapping Malocclusion means a malocclusion which severely interferes with the ability of a person to chew food, as determined by Us.
HCDFB-DFS426
01-18
Employee The term Employee means, an individual meeting the eligibility criteria determined by Your Employer and who is enrolled for dental coverage and for whom all required premiums have been received by Us. Also referred to as “You” or “Your.”
HCDFB-DFS433
01-18
Maximum Benefit Amount The term Maximum Benefit Amount means the maximum dollar amount payable under the plan for Covered Dental Services for each Covered Person in a Calendar Year. No further benefits are payable after the Maximum Benefit Amount is reached.
HCDFB-DFS427
06-21
Employer The term Employer means the Policyholder and all Affiliated Employers.
HCDFB-DFS438
06-21
Maximum Reimbursable Charge (MRC) The Maximum Reimbursable Charge (MRC) for Covered Dental Services is determined based on the lesser of: • the provider’s normal charge for a similar service or supply; or • the Policyholder-selected percentile of charges made by providers of such service or supply in the geographic area where it is received as compiled in a database selected by Us and updated annually. If sufficient data is unavailable in the database for that geographic area to determine the Maximum Reimbursable Charge, then state, regional or national data may be used. If sufficient data is unavailable in the database, then data in the database for similar services may be used. The percentile used to determine the Maximum Reimbursable Charge is listed in The Schedule.
HCDFB-DFS428
06-21
Full-Time The term Full-Time means the number of hours set by the Employer as a regular work-week for persons in an Eligible Class.
HCDFB-DFS430
06-21
Functioning Natural Tooth The term Functioning Natural Tooth means a natural tooth which is performing its normal role in the mastication (i.e., chewing) process in the Covered Person’s upper or lower arch and which is opposed in the Covered Person’s other arch by another natural tooth or prosthetic (i.e., artificial) replacement.
myCigna.com
27
Made with FlippingBook flipbook maker