Jefferson Pilot Life Ins.#1 - Laserfiche WebLink

Home Browse Search

AMENDMENT TO BE ATTACHED TO AND MADE PART OF GROUP POLICY NO.: XXXXXXXXXXX 0SSUED TO: Florida - Dental Specimen PRIOR CARRIER CREDIT PROVISION. This provision applies when: (1) the Schedule of Benefits shows that the Prior Carrier Credit Provision applies; and (2) the Covered Person: (a) is covered under the Group Policyholder's prior group dental plan on the day before Dental Expense Benefits under this Policy take effect; and (b) immediately becomes covered under this dental plan on the day the Group Policyholder's Dental Expense Benefits under this Policy take effect. If this provision applies, then the Covered Person's Dental Expense Benefits will be payable as follows. (1) Any amounts used to satisfy the Covered Person's Deductible under the prior plan will be credited towards the satisfaction of his or her Deductible under this Policy; provided: (a) the expenses would be Covered Expenses under this Policy; (b) the expenses are incurred during the same Calendar Year in which Dental Expense Benefits under this Policy take effect; and (c) the Covered Person sends the Company a claim worksheet explaining the benefits paid by the prior plan. (2) The Covered Person's continuous months of coverage under the prior plan just before it terminated will count towards this Policy's Benefit Waiting Period for Type II Procedures (Basic Care) or Type III Services (Major Care), if any. (3) Expense that the Covered Person incurs for initial placement of a prosthetic appliance or fixed bridge will be covered; provided: (a) the placement is needed to replace one or more natural teeth extracted while insured for Dental Expense Benefits under this Policy or under the prior plan; (b) the replacement would have been covered under the prior plan; and • (c) the extracted teeth are not third molars (wisdom teeth). This amendment takes effect on the day the Group Policyholder's Dental Expense Benefits under this Policy take effect. In all other respects, this Policy remains the same. Error! Not a valid filename. • GL 11- R -PIC.2 Jefferson Pilot Financial Insurance Company 37 09/01/01