Coinsurance The term Coinsurance means the percentage of charges for Covered Dental Expenses that a Covered Person is required to pay under the plan.
bill You for the difference. Non-participating Dentists are under no obligation to limit the amount of their fees.
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-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-DFS395
06-21
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-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-DFS396
06-21
Certificate The term Certificate means this document, including any riders and attachments hereto, which sets forth Your benefits under the plan.
HCDFB-DFS408
06-21
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-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-DFS404
01-18
HCDFB-DFS409
06-21
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