Alternate Benefits. If UCD determines that a less costly covered service other than the covered service the Dentist performed could have been performed to treat a dental condition, we will pay benefits based upon the less costly service if such service would produce a professionally acceptable result under generally accepted dental standards. If the Member and the Dentist choose the more expensive treatment, the Member will be responsible for the additional charges, beyond those allowed under this clause. This limitation does not apply to covered implantology services. Alternate benefits applicable to your treatment plan will be determined during Authorization. However, should the services billed differ from those Authorized, UCD reserves the right to determine if an Alternate Benefit is applicable to the actual services rendered.
Alternate Benefits. In all cases in which there is more than one Course of Treatment or service to treat a Participant’s dental condition, the benefit will be based on the least costly Course of Treatment or covered service, as determined by the Plan.
Alternate Benefits. If Claims Administrator determines that a less costly covered service other than the covered service the Dentist performed could have been performed to treat a dental condition, we will pay Benefits based upon the less costly service if such service would produce a professionally acceptable result under generally accepted dental standards. If the Member and the Dentist choose the more expensive treatment, the Member will be responsible for the additional charges, beyond those allowed under this clause. This limitation does not apply to covered implantology services. Alternate Benefits applicable to your treatment plan will be determined during Authorization. However, should the services billed differ from those Authorized, Claims Administrator reserves the right to determine if an Alternate Benefit is applicable to the actual services rendered. If a Member has other coverage for dental Benefits, and this Contract is offered in conjunction with or as a supplement to that other dental coverage, the dental Benefits under this stand-alone coverage will be determined first. We reserve the right to make any coordination of Benefits necessary so that no more than the full amount of the Allowable Charge for the same claim or service is ever paid under all the dental Benefits the Member may have. The dental coverage under this Section will be extended after the date the coverage for the Member terminates only if: A Covered Benefit for such service was incurred while coverage was in effect; and Such Covered Benefit is completed within thirty-one (31) days after coverage terminates.
Alternate Benefits. If Claims Administrator determines that a less costly covered service other than the covered service the Dentist performed could have been performed to treat a dental condition, we will pay benefits based upon the less costly service if such service would produce a professionally acceptable result under generally accepted dental standards. If the Member and the Dentist choose the more expensive treatment, the Member will be responsible for the additional charges, beyond those allowed under this clause. This limitation does not apply to covered implantology services. Alternate benefits applicable to your treatment plan will be determined during Authorization. However, should the services billed differ from those Authorized, Claims Administrator reserves the right to determine if an Alternate Benefit is applicable to the actual services rendered.
Alternate Benefits. An alternative benefit in the form of a cash payment is available to those full-time employees in regular or probationary status who: (1) elect to opt-out of receiving City contributions under section 6.02 and 6.03; (2) are not enrolled in a City- sponsored health insurance plan as the dependent of another City employee; and (3) provide proof of medical insurance coverage from a plan other than a City-sponsored plan. Any cash payment provided under this section shall be reported to the Internal Revenue Service (IRS) and the California Franchise Tax Board as compensation subject to income tax withholding. Each employee shall be solely and personally responsible for any tax liability that may arise out of receipt of the alternative benefits provided under this section. The amount of alternative benefit provided to an employee is based on the level of insurance coverage that employee could have received if he or she had enrolled in a City-sponsored health insurance plan. Effective July 1, 2013, the amount of the alternative benefit provided under this section shall no longer increase with the growing cost of health care, and as such, shall be frozen at the 2013 Bay Area Basic Kaiser health plan premium rates (i.e. $668.63 for employee only, $1,337.26 for employee and one (1) dependent, $1,738.44 for employee and two (2) or more dependents. Each employee shall be responsible for providing immediate written notification to the Human Resources Director or designee of any change to the number of dependents which affects the amount of the City’s payment to the Alternative Benefit Account. An employee who, by reason of failing to report a change in dependents, receives a City payment greater than the amount to which entitled shall be liable for refunding the excess amounts received via a reduction in the amount paid to his/her Alternative Benefit Account. Changes to benefit payments required because of a change in an employee’s number of dependents shall take effect at the start of the first pay period in the month next following the month in which advice from the employee is received by the Human Resources Director. No retroactive increases to the City’s payment shall be allowed. Enrollment in alternative benefits has to be elected each year during open enrollment.
Alternate Benefits. If Claims Administrator determines that a less costly covered service other than the covered service the Dentist performed could have been performed to treat a dental condition, we will pay benefits based upon the less costly service if such service would produce a professionally acceptable result under generally accepted dental standards. If the Member and the Dentist choose the more expensive treatment, the Member will be responsible for the additional charges, beyond those allowed under this clause. This limitation does not apply to covered implantology services. Alternate benefits applicable to your treatment plan will be determined during Authorization. However, should the services billed differ from those Authorized, Claims Administrator reserves the right to determine if an Alternate Benefit is applicable to the actual services rendered. If a Member has other coverage for dental benefits, and this Benefit Plan is offered in conjunction with or as a supplement to that other dental coverage, the dental benefits under this stand-alone coverage will be determined first. We reserve the right to make any coordination of benefits necessary so that no more than the full amount of the Allowable Charge for the same claim or service is ever paid under all the dental benefits the Member may have. A Covered Benefit for such service was incurred while coverage was in effect; and Such Covered Benefit is completed within thirty-one (31) days after coverage terminates. For appliances or changes to appliances – on the date the appliance or prosthesis is permanently placed; For Crowns, dentures or bridgework – on the date the impression is taken; For Root Canal therapy -- on the date the pulp chamber is opened; or If eligibility for Group coverage ceases upon the death of the Subscriber, a surviving Spouse covered as a Dependent who is fifty (50) years of age or older, has ninety (90) days from the date of the Subscriber's death to notify Company of his election to continue the same coverage for himself, and if already covered, for his Dependent children. • Coverage is automatic during the ninety (90) day election period. Premium is owed for this coverage. If continuation is not chosen, or if premium is not received for the ninety 90 days of automatic coverage, the ninety (90) days of automatic coverage is terminated retroactive to the end of the billing cycle in which the death occurred. • If the continuation coverage is chosen within the ninety (90) day period, cove...
Alternate Benefits. Ameritas’ dental plans include provisions for alternate benefits. If two or more procedures are adequate and appropriate treatment to correct a certain condition, Ameritas’ payment will be based on the charge for the least expensive procedure. Should Dentist perform a different method of treatment, the Dentist may collect from the Covered Person the difference in amounts described in Section V. (A) between the procedure actually reported and the alternate benefit.
Alternate Benefits. With respect to any state in which Supplementation is not permitted, the parties shall endeavor to negotiate an agreement establishing a plan for Alternate Benefits not inconsistent with the purposes of the Plan. Any agreement so reached shall not apply to an Employee who is ineligible to receive a State System Benefit for any of the reasons stated in Section (1)(b) of Article I of the Plan. Such Employee if otherwise eligible, may apply for and receive a Regular Benefit under the Plan. Automatic Short Week Benefits will be payable to an eligible Employee in such state.
Alternate Benefits. A. An alternative benefit in the form of a cash payment is available to those full-time employees in regular or probationary status who: (1) elect to opt-out of receiving City contributions under Section 7.01, Medical Insurance, and 7.02, Flexible Benefits Allowance; (2) are not enrolled in a City-sponsored health insurance plan as the dependent of another City employee; and (3) provide proof of medical insurance coverage from a plan other than a City-sponsored plan. Any cash payment provided under this Section shall be reported to the Internal Revenue Service (IRS) and the California Franchise Tax Board as compensation subject to income tax withholding. Each employee shall be solely and personally responsible for any tax liability that may arise out of receipt of the alternative benefits provided under this Section. The alternative benefit provided to an employee is based on the level of insurance coverage that the employee could have received if the employee had enrolled in a City-sponsored health insurance plan, as follows: Employee only $210.00 per month Employee and one dependent $380.00 per month Employee and two + dependents $500.00 per month For the purpose of this Section, the term "dependent'' shall mean a dependent eligible for coverage under a CalPERS medical insurance plan if such coverage had otherwise been elected by the employee.
B. Enrollment in alternative benefits must be elected each year during open enrollment. Benefit eligibility and alternative benefit amounts may vary from year to year depending on plan premiums.
C. The provisions of this Section shall be administered in accordance with regulations issued by the City Manager or designee which shall include, but not be limited to: the method and frequency of reimbursement to employees for the alternate benefits program(s) selected, the frequency with which employees may exercise the option to change alternate benefits programs, and appropriate procedures for the verification of payments made in pursuance of this Section.
Alternate Benefits. If more than one Covered Service will treat a dental condition, payment is limited to the least costly service provided it is a professionally accepted, necessary and appropriate treatment, as determined by the Plan. If you or your Dentist requests or you accept a costlier Covered Service, you are responsible for expenses that exceed the amount covered for the least costly service.
