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Reso 2001-399
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Reso 2001-399
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Last modified
6/11/2013 4:45:14 PM
Creation date
1/25/2006 1:56:58 PM
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CityClerk-Resolutions
Resolution Type
Resolution
Resolution Number
2001-399
Date (mm/dd/yyyy)
12/13/2001
Description
– Bid 01-10-01: Jefferson Pilot Life Ins&Eye Med: Emp Dental Vision etc.
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<br />DEFINITIONS <br />(continued) <br /> <br />lROUP POLICYHOLDER means the person, partnership, corporation, or trust as shown on the Title Page of this Policy, <br /> <br />LATE ENTRANT means an eligible Employee who makes written application: <br />(1) more than 31 days after the Employee ftrst becomes eligible for Employee Dental Coverage; <br />(2) after Employee Dental Coverage has been cancelled; or <br />(3) after Employee Dental Coverage has been terminated due to failure to pay premiums when due. <br /> <br />LATE ENTRANT also means an eligible Dependent for whom written application is made: <br />(I) more than 31 days after he or she fIrst qualifIes for Dependent Dental Coverage; <br />(2) after the Covered Employee has requested to terminate Dependent Dental Coverage; or <br />(3) after Dependent Dental Coverage has been terminated due to failure to pay premiums when due. <br /> <br />A person will not be considered to be a Late Entrant if the Employee's spouse was covered under an employer's group dental plan; and <br />the spouse's dental coverage was terminated due to: <br />(1) termination of the dental plan by the spouse's employer; or <br />(2) loss of the spouse's eligibility due to termination of employment or change in the spouse's employment <br />classifIcation. <br /> <br />In order to qualify for waiving the Late Entrant Limitation, each person applying for coverage under the Group Policyholder's dental <br />plan must: <br />(1) provide proof of coverage under the spouse's prior dental plan; and <br />(2) enroll for coverage and pay premiums for the Group Policyholder's plan within 31 days following the loss of <br />coverage under the spouse's plan. <br /> <br />NECESSARY DENTAL PROCEDURE (includes NECESSARY and DENTAL NECESSITY) means a procedure, service or <br />mpply which the Company, or a qualifIed party selected by the Company, determines is: <br />(1) required by, and Adequate and Appropriate for the diagnosis or treatment ofa dental disease, condition or injury; <br />(2) Appropriate and consistent with the symptoms and fmdings, or with the diagnosis and treatment of the Covered <br />Person's dental disease, condition or injury; <br />(3) provided in accord with the generally accepted professional standards for dental practice; <br />(4) on the List of Dental Procedures contained in this Policy; and <br />(5) the most Appropriate and Professionally Adequate level of service or supply which can be provided on a cost <br />effective basis without adversely affecting the Covered Person's dental condition, <br /> <br />Necessary Dental Procedures include the Diagnostic and Preventive Services contained in the List of Dental Procedures contained in <br />this Policy, <br /> <br />The fact that a person's Dentist prescribes a service or supply does not automatically mean that such services or supplies are <br />considered as Necessary Dental Procedures and are covered by this Policy. <br /> <br />GL 11-4.2-DF <br /> <br />6 <br /> <br />09/01/01 <br />
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