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”).
• if the order is a National Medical Support Notice completed in accordance with the Child Support Performance and Incentive Act of 1998, such notice meets the requirement above.
HCDFB-DFS457
01-19
HCDFB-DFS448
06-21
Specialist The term Specialist means a Dentist who focuses on a specific area of dentistry, including oral surgery, endodontia, periodontia, orthodontia, pediatric dentistry or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions.
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-DFS454
06-21
HCDFB-DFS459
01-18
Policyholder The term Policyholder means the owner of the group Policy as identified on the certification page.
Spouse The term Spouse means Your legally recognized Spouse in the state where You reside.
HCDFB-DFS455
06-21
HCDFB-DFS460
06-21
Qualified Medical Child Support Order A Qualified Medical Child Support Order is a judgment, decree or order (including approval of a settlement agreement) or administrative notice, which is issued pursuant to a state domestic relations law (including a community property law), or to an administrative process, which provides for child support or provides for health benefit coverage to such child and relates to benefits under the group health plan, and satisfies all of the following: • the order recognizes or creates a child’s right to receive group health benefits for which a participant or beneficiary is eligible; • the order specifies Your name and last known address, and the child’s name and last known address, except that the name and address of an official of a state or political subdivision may be substituted for the child’s mailing address; • the order provides a description of the coverage to be provided, or the manner in which the type of coverage is to be determined; • the order states the period to which it applies; and
Usual Fee The fee that an individual Dentist most frequently charges for a given dental service.
HCDFB-DFS461
01-18
We, Us and Our The terms We, Us and Our mean Cigna Health and Life Insurance Company.
HCDFB-DFS462
01-18
You, Your, Yourself The Employee and/or any of his/her Dependents.
HCDFB-DFS463
01-18
myCigna.com
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