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.
Deductible The term Deductible means expenses to be paid by You or Your Dependents before benefits are paid under the Policy.
HCDFB-DFS412
01-18
HCDFB-DFS408
06-21
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.
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; • 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-DFS414
06-21
Dependent The term Dependent means: • Your lawful Spouse; and • any child of Yours who is: • less than 26 years old.
• 26 or more years old, unmarried, and primarily supported by You and incapable of self-sustaining employment by reason of intellectual or physical disabilities. Proof of the child's condition and dependence may be required to be submitted to Us within 31 days after the date the child ceases to qualify above. The term child means a child born to You or a child legally adopted by You. It also includes a stepchild, a foster child, a child for whom You are the legal guardian or a child supported pursuant to a court order imposed on You (including a Qualified Medical Child Support Order). Benefits for a Dependent child will continue until the last day of the calendar month in which the limiting age is reached. Anyone who is eligible as an Employee will not be considered as a Dependent. No one may be considered as a Dependent of more than one Employee.
HCDFB-DFS409
06-21
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.
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-DFS415
06-21
HCDFB-DFS411
01-18
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