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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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COORDINATION OF DENTAL EXPENSE BENEFITS <br />4FECT ON BENEFITS. If a Covered Person is covered by another Plan, the Dental Expense Benefits under this Policy and <br />nefits under the other Plan(s) will be coordinated for the Claim Period. The Order of Benefit Determination Rules on the next page <br />decide which Plan pays first. <br />(1) Primary Benefits. When this Plan must pay its full benefits first, the Dental Expense Benefits under this Policy <br />will be paid as if the other coverage did not exist. <br />(2) Secondary Benefits. When another Plan must pay its full benefits first, the Dental Expense Benefits under this <br />Policy: <br />(a) will be calculated as if the other coverage did not exist; and then <br />(b) will be reduced so that total benefits, from all Plans combined, will not exceed 100% of the <br />Allowable Expenses incurred by the Claimant during that Claim Period. <br />Benefits will be coordinated with any benefit amounts that would be payable for the Allowable Expenses under the other Plan(s), <br />whether or not claim is actually made. When this Plan's benefits are reduced, each benefit is reduced in proportion. Then, the <br />reduced benefit payments are applied towards the Maximums of this Plan. <br />BENEFIT SAVINGS. The amount by which this Plan's benefits have been reduced due to such coordination will accrue during the <br />Claim Period. This amount will be used to pay any Allowable Expenses which: <br />(1) are incurred by that Claimant during the same Claim Period; and <br />(2) are not otherwise paid by any Plan. <br />DEFINITIONS. The following definitions apply only to this coordination provision. <br />"Plan" means any group hospital, surgical, medical or dental expense policy, group health care services plan, or group type self - <br />46 . surance plan that provides protection or insurance against hospital, surgical, medical or dental expenses or services, including: <br />(1) Blue Cross and Blue Shield group plans; <br />(2) Health Maintenance Organization (HMO) and Dental Maintenance Organization (DMO) plans; and <br />(3) other prepayment, group practice and individual practice plans. <br />It also includes any coverage under a government medical or dental plan required or provided by law; except Medicaid. This Plan <br />must pay its benefits before Medicaid pays. Coordination with Medicare will be in accord with federal law. <br />Each of the above coverages is a separate Plan. If an arrangement has two or more parts, and its coordination provision applies only <br />to some benefits or services; then each part is a separate plan. <br />"Allowable Expense" means any necessary, reasonable and customary expense for dental care, which is at least partly covered under <br />at least one of the Plans covering the Claimant. When a Plan provides benefits in the form of services rather than cash payments, the <br />reasonable cash value of each service rendered during the Claim Period will be considered Allowable Expense. <br />"Claimant" means the Covered Person for whom claim is made. <br />"Claim Period" means a calendar year (or part of a calendar year) during which the Claimant has been covered under this Policy. <br />• <br />GL I -17 -COB FL Savings <br />23 09/01/01 <br />
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