Common use of Administrative Manual Clause in Contracts

Administrative Manual. Policies, procedures and interpretations to be used in administering Dental Expense Benefits shall be incorporated in an Administrative Manual. Among other things the Manual shall: (A) Explain the benefits and the rules and regulations governing their payment. (B) Include administrative practices and interpretations which affect benefits. (C) Define professionally recognized standards of practice to be applied to benefits and procedures. (D) List the eligibility provisions and limitations and exclusions of the coverage, and procedures for status changes and termination of coverage. (E) Provide the basis upon which charges will be paid, including provisions for the benefit payment mechanism and protection of individuals against excess charges. (F) Provide for cost and quality controls by means of predetermination of procedures and charges, utilization and peer review, clinical post treatment evaluation and case reviews involving individual consideration of fees or treatment.

Administrative Manual. Policies, procedures and interpretations to be used in administering Dental Expense Benefits shall be incorporated in an Administrative Manual. Among other things the Manual shall: (A) Explain the benefits and the rules and regulations governing their payment. (B) Include administrative practices and interpretations which affect benefits. (C) Define professionally recognized standards of practice to be applied to benefits and procedures. (D) List the eligibility provisions and limitations and exclusions of the coverage, and procedures for status changes and termination of coverage. (E) Provide the basis upon which charges will be paid, including provisions for the benefit payment mechanism and protection of individuals against excess charges. (F) Provide for cost and quality controls by means of predetermination of procedures and charges, utilization and peer review, clinical post post-treatment evaluation and case reviews involving individual consideration of fees or treatment.