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<br />AMENDMENT TO BE ATIACHED TO AND MADE PART OF GROUP POLICY NO.: XXXXXXXXXXX <br /> <br />ISSUED TO: Florida - Dental Specimen <br /> <br />PRIOR CARRIER CREDIT PROVISION. This provision applies when: <br />(1) the Schedule of BenefIts shows that the Prior Carrier Credit Provision applies; and <br />(2) the Covered Person: <br />(a) is covered under the Group Policyholder's prior group dental plan on the day before Dental <br />Expense BenefIts under this Policy take effect; and <br />(b) immediately becomes covered under this dental plan on the day the Group Policyholder's Dental <br />Expense BenefIts under this Policy take effect. <br /> <br />If this provision applies, then the Covered Person's Dental Expense BenefIts will be payable as follows, <br />(1) Any amounts used to satisfy the Covered Person's Deductible under the prior plan will be credited towards the <br />satisfaction of his or her Deductible under this Policy; provided: <br />(a) the expenses would be Covered Expenses under this Policy; <br />(b) the expenses are incurred during the same Calendar Year in which Dental Expense BenefIts under <br />this Policy take effect; and <br />(c) the Covered Person sends the Company a claim worksheet explaining the benefIts paid by the <br />prior plan. <br />(2) The Covered Person's continuous months of coverage under the prior plan just before it terminated will count <br />towards this Policy's BenefIt Waiting Period for Type II Procedures (Basic Care) or Type III Services (Major <br />Care), ifany. <br />(3) Expense that the Covered Person incurs for initial placement of a prosthetic appliance or fIxed bridge will be <br />covered; provided: <br />(a) the placement is needed to replace one or more natural teeth extracted while insured for Dental <br />Expense BenefIts under this Policy or under the prior plan; <br />(b) the replacement would have been covered under the prior plan; and <br />(c) the extracted teeth are not third molars (wisdom teeth), <br /> <br />This amendment takes effect on the day the Group Policyholder's Dental Expense BenefIts under this Policy take effect. In all other <br />respects, this Policy remains the same. <br /> <br />Jefferson Pilot Financial Insurance Company <br /> <br />Error! Not a valid rIlename. <br /> <br />GL11-R-PIC.2 <br /> <br />37 <br /> <br />09/01/01 <br />