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Jefferson Pilot Life Ins.#1
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RFP No. 01-10-01 Employee Dental, Life, Insurance
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Jefferson Pilot Life Ins.#1
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Last modified
6/18/2012 10:02:26 PM
Creation date
12/28/2010 3:46:06 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Employee Insurance
Bid No. (xx-xx-xx)
01-10-01
Project Type (Bid, RFP, RFQ)
RFP
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DENTAL EXPENSE BENEFITS <br />lNEFIT. The Company will pay Dental Expense Benefits if a Covered Person incurs Covered Expenses in excess of the <br />ductible 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 />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 />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 />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 />11 be based on those Covered Expenses which are in excess of the Deductible. <br />0'fter Covered Expenses Incurred b all covered family members combined exceed the Family Deductible shown in the Schedule of <br />P Y Y Y <br />Benefits, no additional Covered Expenses will be applied toward the Deductible in that Calendar Year. <br />BENEFIT WAITING PERIOD. The Benefit Waiting Period is shown on the Schedule of Benefits page of this Policy. <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 />GL 11 -12 -DB <br />18 09/01/01 <br />
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