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<br />.' <br /> <br />DEFINITIONS <br />(continued) <br /> <br />iON-PARTICIPATING DENTIST means a Dentist who is not participating in the dental network being made available through <br />this Policy. <br /> <br />PARTICIPATING DENTIST means a Dentist who: <br />(1) has signed a contract with the dental network being made available through this Policy; and <br />(2) has agreed to abide by the rules of that network. <br /> <br />The Company will periodically provide the Group Policyholder with a listing of Participating Dentists for distribution to Covered <br />Employees, It is the Covered Employee's responsibility to verify whether the Dentist is a Participating Dentist at the time of service. <br />Participating Dentists are independent contractors; they are not employees or agents of the network or the Company, The Company <br />does not supervise, control or guarantee the services of the Participating Dentist or any other Dentist. <br /> <br />POLICY means this group dental policy issued by the Company to the Group Policyholder. <br /> <br />PROFESSIONALLY ADEQUATE (includes ADEQUATE) means the least expensive form of treatment, within the range of <br />Appropriate Treatments, for a given dental condition, that conforms to the accepted standards of dentistry, <br /> <br />TYPE (includes TYPE OF SERVICE) means a level of dental services, contained in the List of Dental Procedures and covered by <br />this Policy: <br />(1) TYPE I procedures are categorized as Diagnostic & Preventive Services, such as routine oral exams, dental x- <br />rays and cleanings; <br />(2) TYPE n procedures are categorized as Basic Services, such as fIllings, extractions and many oral surgeries; <br />(3) TYPE ill procedures are categorized as Major Services. Major services are generally considered the most <br />complex and expensive dental care, including crowns and dentures; and <br />(4) TYPE IV procedures provide Orthodontic Care, <br /> <br />USUAL, CUSTOMARY AND REASONABLE (VCR) means the allowable charge for a procedure which is the lesser of: <br />(1) the amount usually charged by that Dentist for the same or similar procedure(s); or <br />(2) the amount charged by most other Dentists, with similar training and experience within the same geographic area, <br />for a comparable service. <br />The Company will determine the size of the area needed to obtain an accurate cross-section of dental charges data. "Area" means a <br />city, a county, a metropolitan area or a greater area, if needed to frod a cross section of Dentist performing the same or similar <br />procedure. <br /> <br />If Covered Expenses are Incurred outside of the United States, the UCR allowance will be the amount that would be allowed for that <br />procedure if it had been performed at the Company's Home Office in Omaha, Nebraska. <br /> <br />GL 11-4,3-DF <br /> <br />7 <br /> <br />09/01/01 <br />