Jefferson Pilot Life Ins.#1 - Laserfiche WebLink

Home Browse Search

SUNNYISLES 1703779 City of Sunny Isles Beach Covered persons can be given 'credit' toward: • _ covered charges applied to the prior plan's DEDUCTIBLE during the same calendar year. the BENEFIT WAITING PERIOD, if included in the policy, for each covered person's continuous months of coverage under the prior plan just before it terminated. (The 'credit' applies only if the prior plan included the Type(s) of coverage which are subject to the new policy's benefit waiting period.) The provision also extends coverage for replacement of natural teeth lost while covered under the prior plan. BENEFIT WAITING PERIOD The policy may include a benefit waiting period for employees and dependents. The benefit waiting period is a period of time a person must be covered by the plan before some of the more extensive dental procedures are covered. In takeover situations, credit toward benefit waiting periods may be given for the time employees and dependents were covered under the employer's previous plan. ALTERNATIVE BENEFITS The policy covers expenses incurred for necessary dental treatment. However, there may be two or more methods of treating a dental condition. In that case, the amount of covered expense will be limited to the charge for the least costly procedure which Jefferson Pilot Financial determines to be appropriate and adequate. This determination is based on current professional dental standards and the patient's total oral condition. PREDETERMINATION OF BENEFITS erhe policy includes a provision which allows the patient and the dentist to find out, before the work is done, how much of the dentist's charge will be covered by the plan. Jefferson Pilot Financial recommends that this predetermination be used whenever a dentist's charges for non - emergency treatment are expected to exceed $300. REQUIRED TMJ COVERAGE The proposed plan includes coverage for surgical and non - surgical treatment of disorders of the temporomandibular joint (TMJ), as required by state law. This treatment can include examinations, x -rays and surgery (including general anesthesia and postoperative care). If coverage for Type IV services is elected, TMJ benefits also would be payable for installation of braces or orthotic devices for eligible participants. LATE ENTRANT LIMITATION The policy may include a late entrant limitation of benefits. If included in the policy, the limitation says: When an employee or dependent: - is enrolled in the dental plan for more than 31 days after first becoming eligible; or - cancels then re- enrolls for coverage benefits are limited to Type I Services for the first 12 months of coverage. is Jefferson Pilot Financial Insurance Company FL 28 11/2/01