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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 />DENTAL EXPENSE BENEFITS <br /> <br />'"\ENEFIT, The Company will pay Dental Expense BenefIts if a Covered Person incurs Covered Expenses in excess of the <br />..Jeductible during a Calendar Year. The Company will pay the Percentage Payable shown in the Schedule of BenefIts for that Type <br />of service; provided any BenefIt Waiting Period is satisfIed. BenefIts will be paid up to the Maximum shown in the Schedule of <br />BenefIts for each Covered Person. <br /> <br />BENEFIT DETERMINATION. The amount of benefIts payable for Type I, II and III Procedures will be determined as follows: <br />(1) Dates of service are reviewed and categorized by: <br />(a) services prior to effective date; <br />(b) services after termination date; and <br />(c) covered services by benefIt period or calendar year. <br />(2) Each procedure, service or supply is evaluated to ensure that it qualifIes as a Necessary Dental Procedure which is <br />determined to be Professionally Adequate under the terms of the Policy. <br />(3) Covered Expenses are determined, then grouped by Type of dental service. The Covered Expenses for each Type <br />are added, <br />(4) The total for each Type of dental service is reduced by any unmet Deductible amount. The total is reduced: <br />(a) for Type I Procedures fIrst, if the Deductible applies to Diagnostic and Preventive Procedures; <br />(b) for Type II Procedures next; and for Type III, last. <br />(5) Then, each remaining amount is multiplied by the Percent Payable for that Type of Service, to determine the <br />Dental Expense BenefIts payable, subject to Policy provisions, maximums, limitations and exclusions. <br /> <br />BenefIts for Covered Expenses are based on Dental Necessity, Services which are determined to be not Necessary are not covered by <br />this Policy, even if they are recommended or provided by a Dentist. <br /> <br />DEDUCTIBLE. The Deductible shown in the Schedule of BenefIts is the amount of Covered Expenses which must be incurred <br />before benefIts are payable, The Deductible applies separately to the Covered Expenses incurred by each Covered Person, BenefIts <br />will be based on those Covered Expenses which are in excess of the Deductible, <br /> <br />After Covered Expenses Incurred by all covered family members combined exceed the Family Deductible shown in the Schedule of <br />BenefIts, no additional Covered Expenses will be applied toward the Deductible in that Calendar Year. <br /> <br />BENEFIT WAITING PERIOD. The BenefIt Waiting Period is shown on the Schedule of BenefIts page of this Policy, <br /> <br />LATE ENTRANT LIMITATION. For a Late Entrant, Dental Expense BenefIts will be limited to Type I benefIts only; until the <br />Late Entrant has completed the Late Entrant Limitation, for each Type of service shown on the Schedule of BenefIts page. <br /> <br />GL11-12-DB <br /> <br />18 <br /> <br />09101/01 <br />
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