Eligibility Waiting Period. The period that must pass before an individual is eligible to receive Benefits under this Benefit Plan. If an individual enrolls as a Special Enrollee, any period before such Special Enrollment is not a waiting period. A Plan Participant must satisfy any Eligibility Waiting Periods established by the Group before dental coverage is effective and prior to satisfying the Dental Waiting Period. Eligible Person – A person entitled to apply to be an Employee or Dependent as specified in the Schedule of Eligibility. Employee – An Eligible Person who has satisfied the specifications of this Benefit Plan's Schedule of Eligibility and has enrolled for coverage, and to whom the Plan Administrator has issued a copy of this Benefit Plan. Endodontic (Pulpal) Therapy – A dental procedure that is performed when the decay in a child's tooth reaches into the pulp (nerve) tissue. The infected part of the nerve tissue within the crown portion of the tooth is removed to prevent further inflammation and spread of disease (caries). During this treatment, the diseased pulp tissue is partially or completely removed from both the crown and the roots of the tooth. The canals are cleansed, disinfected, and filled with a special material. Enrollment Date – The first day of coverage under this Benefit Plan or, if there is an Eligibility Waiting Period, the first day of the Eligibility Waiting Period. Expedited Appeal – A request for immediate review of an Adverse Benefit Determination involving an Admission, availability of care, continued Hospital stay, or health care service for which a Plan Participant has received Emergency services, but has not been discharged from a facility, which involves any of the following:
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Samples: Group Dental Care and Treatment Contract, Group Dental Care and Treatment Contract
Eligibility Waiting Period. The period that must pass before an individual is eligible to receive Benefits under this Benefit Plan. If an individual enrolls as a Special Enrollee, any period before such Special Enrollment is not a waiting period. A Plan Participant must satisfy any Eligibility Waiting Periods established by the Group before dental coverage is effective and prior to satisfying the Dental Waiting Period. Eligible Person – A person entitled to apply to be an Employee or Dependent as specified in the Schedule of Eligibility. Employee – An Eligible Person who has satisfied the specifications of this Benefit Plan's Schedule of Eligibility and has enrolled for coverage, and to whom the Plan Administrator has issued a copy of this Benefit Plan. Endodontic (Pulpal) Therapy – A dental procedure that is performed when the decay in a child's tooth reaches into the pulp (nerve) tissue. The infected part of the nerve tissue within the crown portion of the tooth is removed to prevent further inflammation and spread of disease (caries). During this treatment, the diseased pulp tissue is partially or completely removed from both the crown and the roots of the tooth. The canals are cleansed, disinfected, and filled with a special material. Enrollment Date – The first day of coverage under this Benefit Plan or, if there is an Eligibility Waiting Period, the first day of the Eligibility Waiting Period. Expedited Appeal – A Any request for immediate review of an Adverse Benefit Determination involving concerning an Admission, availability of care, continued Hospital stay, or health care healthcare service for which a Plan Participant covered person or his authorized representative who is requesting Emergency servic es or has received Emergency services, but has not been discharged from a facility. Grievance – A written expression of dissatisfaction with the Plan Administrator or with Provider services. Group – Any company, partnership, association, corporation or other legal entity which involves any has made application for coverage herein and has agreed to comply with all the terms and requirements of this Benefit Plan. For the purposes of this Benefit Plan, the Group is the policyholder. Informal Reconsideration – A request by telephone for additional review of a utilization management determination not to authorize. Informal Reconsideration is available only for initial or Concurrent Review determinations that are requested within ten (10) days of denial. Investigational – A dental treatment, service, procedure, drug, device, or biological product is Inves t igational if the effectiveness has not been clearly tested and it has not been incorporated into standard dental practice. Any determination the Plan makes that a dental treatment, procedure, drug, device, or biological product is Investigational will be based on a consideration of the following:
Appears in 1 contract
Eligibility Waiting Period. The period that must pass before an individual is eligible to receive Benefits under this Benefit Plan. If an individual enrolls as a Special Enrollee, any period before such Special Enrollment is not a waiting period. A Plan Participant must satisfy any Eligibility Waiting Periods established by the Group before dental coverage is effective and prior to satisfying the Dental Waiting Period. Eligible Person – A person entitled to apply to be an Employee Employee, Retiree or Dependent as specified in the Schedule of Eligibility. Employee – An Eligible Person who has satisfied the specifications of this Benefit Plan's Schedule of Eligibility and has enrolled for coverage, and to whom the Plan Administrator has issued a copy of this Benefit Plan. Endodontic (Pulpal) Therapy Employer – A dental procedure that is performed when the decay in a child's tooth reaches into the pulp (nerve) tissue. The infected part Louisiana Conference of the nerve tissue within the crown portion of the tooth is removed to prevent further inflammation and spread of disease (caries). During this treatment, the diseased pulp tissue is partially or completely removed from both the crown and the roots of the tooth. The canals are cleansed, disinfected, and filled with a special material. United Methodist Church Enrollment Date – The first day of coverage under this Benefit Plan or, if there is an Eligibility Waiting Period, the first day of the Eligibility Waiting Period. Expedited Appeal – A Any request for immediate review of an Adverse Benefit Determination involving concerning an Admission, availability of care, continued Hospital stay, or health care service for which a Plan Participant covered person or his authorized representative who is requesting Emergency services or has received Emergency services, but has not been discharged from a facility. Grievance – A written expression of dissatisfaction with the Plan Administrator or with Provider services. Group – Any company, partnership, association, corporation or other legal entity which involves any has made application for coverage herein and has agreed to comply with all the terms and requirements of this Benefit Plan. For the purposes of this Benefit Plan, the Group is the policyholder. Informal Reconsideration – A request by telephone for additional review of a utilization management determination not to authorize. Informal Reconsideration is available only for initial or Concurrent Review determinations that are requested within ten (10) days of denial. Investigational – A dental treatment, service, procedure, drug, device, or biological product is Investigational if the effectiveness has not been clearly tested and it has not been incorporated into standard dental practice. Any determination the Plan makes that a dental treatment, procedure, drug, device, or biological product is Investigational will be based on a consideration of the following:
Appears in 1 contract
Eligibility Waiting Period. The period that must pass before an individual is eligible to receive Benefits under this Benefit Plan. If an individual enrolls as a Special Enrollee, any period before such Special Enrollment is not a waiting period. A Plan Participant must satisfy any Eligibility Waiting Periods established by the Group before dental coverage is effective and prior to satisfying the Dental Waiting Period. Eligible Person – A person entitled to apply to be an Employee Employee, Retiree or Dependent as specified in the Schedule of Eligibility. Employee – An Eligible Person who has satisfied the specifications of this Benefit Plan's Schedule of Eligibility and has enrolled for coverage, and to whom the Plan Administrator has issued a copy of this Benefit Plan. Endodontic (Pulpal) Therapy Employer – A dental procedure that is performed when the decay in a child's tooth reaches into the pulp (nerve) tissue. The infected part Louisiana Conference of the nerve tissue within the crown portion of the tooth is removed to prevent further inflammation and spread of disease (caries). During this treatment, the diseased pulp tissue is partially or completely removed from both the crown and the roots of the tooth. The canals are cleansed, disinfected, and filled with a special material. United Methodist Church Enrollment Date – The first day of coverage under this Benefit Plan or, if there is an Eligibility Waiting Period, the first day of the Eligibility Waiting Period. Expedited Appeal – A Any request for immediate review of an Adverse Benefit Determination involving concerning an Admission, availability of care, continued Hospital stay, or health care healthcare service for which a Plan Participant covered person or his authorized representative who is requesting Emergency services or has received Emergency services, but has not been discharged from a facility. Grievance – A written expression of dissatisfaction with the Plan Administrator or with Provider services. Group – Any company, partnership, association, corporation or other legal entity which involves any has made application for coverage herein and has agreed to comply with all the terms and requirements of this Benefit Plan. For the purposes of this Benefit Plan, the Group is the policyholder. Informal Reconsideration – A request by telephone for additional review of a utilization management determination not to authorize. Informal Reconsideration is available only for initial or Concurrent Review determinations that are requested within ten (10) days of denial. Investigational – A dental treatment, service, procedure, drug, device, or biological product is Investigational if the effectiveness has not been clearly tested and it has not been incorporated into standard dental practice. Any determination the Plan makes that a dental treatment, procedure, drug, device, or biological product is Investigational will be based on a consideration of the following:
Appears in 1 contract
