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.
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
HCDFB-DFS396
06-21
Definitions Active Service You will be considered in Active Service:
Certificate The term Certificate means this document, including any riders and attachments hereto, which sets forth Your benefits under the plan.
• 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.
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-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 under Your plan. This amount is used to help calculate how much will be paid by Your plan.
HCDFB-DFS404
01-18
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-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-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-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-DFS406
06-21
HCDFB-DFS395
06-21
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