Non-Participating Provider The term Non-Participating Provider means a Dentist, or a professional corporation, professional association, partnership, or other entity that has not entered into a Contract with Us to provide dental services. Services received from Non- Participating Providers are considered out-of-network (“Out- of-Network”).
The Maximum Reimbursable Charge is subject to all other benefit limitations and applicable coding and payment methodologies determined by Us. Additional information about how We determine the Maximum Reimbursable Charge is available upon request.
HCDFB-DFS439
06-21
Medicaid The term Medicaid means a state program of medical aid for needy persons established under Title XIX of the Social Security Act of 1965 as amended.
HCDFB-DFS445
06-21
Orthodontic Treatment The term Orthodontic Treatment means the corrective movement of the teeth through the alveolar bone by means of an active appliance to correct a Handicapping Malocclusion of the mouth.
HCDFB-DFS440
01-18
Medically Necessary and/or Dentally Necessary Services provided by a Dentist or physician as determined by Us are Medically Necessary and/or Dentally Necessary if they are: • required for the diagnosis and/or treatment of the particular dental condition or disease; and • consistent with the symptom or diagnosis and treatment of the dental condition or disease; and • commonly and usually noted throughout the medical/dental field as proper to treat the diagnosed dental condition or disease; and • the most fitting level or service which can safely be given to You or Your Dependent. A diagnosis, treatment and service with respect to a dental condition or disease, is not Medically Necessary and/or Dentally Necessary if made, prescribed or delivered solely for convenience of the patient or provider.
HCDFB-DFS446
06-21
Participating Provider The term Participating Provider means: a Dentist, or a professional corporation, professional association, partnership, or other entity which is entered into a Contract with Us to provide dental services at predetermined fees. The providers qualifying as Participating Providers may change from time to time. A list of the current Participating Providers will be provided by Your Employer. Services received from Participating Providers are considered in- network (“In-Network”).
HCDFB-DFS448
06-21
Policy The term Policy means a written agreement between the Policyholder and Us outlining the terms and conditions under which We agree to insure certain Employees and pay benefits.
HCDFB-DFS441
06-21
Medicare The term Medicare means the program of medical care benefits provided under Title XVIII of the Social Security Act of 1965 as amended.
HCDFB-DFS454
06-21
Policyholder The term Policyholder means the owner of the group Policy as identified on the certification page.
HCDFB-DFS442
01-18
HCDFB-DFS455
06-21
myCigna.com
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