Estimate of Eligible Benefits Sample Clauses

Estimate of Eligible Benefits. A Dentist may propose a planned dental treatment or series of dental procedures. A Member may choose to obtain a written estimate of the benefits available for such procedures. CareFirst encourages a Member to obtain a written Estimate of Eligible Benefits (CareFirst’s written estimate of benefits before a service is rendered) also known as a pre- treatment estimate (PTE) for major dental procedures, thereby alerting a Member of the out-of-pocket expenses that may be associated with the treatment plan, related deductibles, co-insurance and/or procedures that are not Covered Dental Services. Based on an Estimate of Eligible Benefits or PTE from CareFirst, a Member can decide whether or not to incur the expense that may be associated with a particular treatment plan. Failure to obtain an Estimate of Eligible Benefits or PTE has no effect on the benefits to which a Member is entitled. A Member may choose to forgo the Estimate of Eligible Benefits or PTE and proceed with treatment. After the services are rendered, the claim will be reviewed by CareFirst. Should the review determine that the service(s) rendered meet CareFirst’s criteria for benefits, the benefits will be provided as described in this Description of Covered Services. However, should the review of the claim determine that the treatment or procedures did not meet CareFirst’s criteria for benefits, benefits will not be provided. To request an Estimate of Eligible Benefits or PTE prior to receiving dental treatment or dental procedures, a Member should contact his or her Dentist who will coordinate the request on the Member’s behalf. If the Dentist has any questions about the process, he or she may contact the CareFirst Provider Services Department or go to the CareFirst website at xxx.xxxxxxxxx.xxx, which lists information in the Physicians and Providers section, under the subsection for Dental, and list of Resources. The Estimate of Eligible Benefits or PTE is merely an estimate, and it cannot be considered a guarantee of the Member’s benefits or enrollment. SAMPLE The process is different for orthodontic services. The Affordable Care Act requires that orthodontics must be Medically Necessary to be Covered Dental Services. To request a PTE for orthodontic services, the Member must see an orthodontist who will do an exam and orthodontic assessment that may include taking orthodontic records (study models and certain x-rays). The orthodontist will then complete a case assessment using a scoring tool...
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Estimate of Eligible Benefits. A Dentist may propose a planned dental treatment or series of dental procedures. A Member may choose to obtain a written estimate of the benefits available for such procedures.

Related to Estimate of Eligible Benefits

  • Flexible Benefits Insurance Program

  • Flexible Benefits Plan A flexible benefits plan, which is in accordance with Section 125 of the Internal Revenue Code, was implemented for eligible employees covered by this Agreement on October 1, 1990.

  • Living Away From Home Allowance When Employees are to be engaged on a Project requiring them to live away from home, the provisions of Appendix I will apply in determining their entitlement and the conditions whilst they are living away from home.

  • Base Compensation The Bank agrees to pay the Employee during the ----------------- term of this Agreement a salary at the rate of $76,000 per annum, payable in cash not less frequently than monthly; provided, that the rate of such salary shall be reviewed by the Board of Directors of the Bank not less often than annually, and Employee shall be entitled to receive annually an increase at such percentage or in such an amount as the Board of Directors in its sole discretion may decide.

  • Rate of Compensation In lieu of direct compensation for all overtime, shift work and standby (as defined in Articles 16, 17 and 18 of this Agreement), regular full-time employees shall receive a special compensation of 7% of their basic salary earned for each calendar year. This special compensation shall not be considered part of the employee's basic salary for the purpose of calculating any benefits or other premium entitlements.

  • Annual Base Salary During the Term, Executive shall receive a base salary at a rate of $550,000 per annum (as increased from time to time, the “Annual Base Salary”), which shall be paid in accordance with the customary payroll practices of the Company. Such Annual Base Salary shall be reviewed (and may be increased, but not decreased) from time to time by the Board or an authorized committee of the Board.

  • Severance Allowance A laid-off employee shall be entitled to severance allowance pursuant to Article 55.

  • Special Compensation The Company shall pay to the Executive a lump sum equal to three times the sum of (a) the highest per annum base rate of salary in effect with respect to the Executive during the three-year period immediately prior to the termination of employment plus (b) the Highest Bonus Amount. Such lump sum shall be paid by the Company to the Executive within ten business days after the Executive's termination of employment, unless the provisions of Section 3(e) below apply. The amount of the aggregate lump sum provided by this Section 3(c), whether paid immediately or deferred, shall not be counted as compensation for purposes of any other benefit plan or program applicable to the Executive.

  • PROFESSIONAL COMPENSATION 11.1 The basic salaries of teachers covered by this Contract shall be set in accordance with the procedures set forth in this Agreement. 11.2 The salary of the teacher will be presumed correct as shown in the Uniform Teacher’s Contract unless the teacher or the Employer furnishes evidence of error. 11.3 An explanation as to how contract salary figures are computed will accompany the first paycheck of each school year. 11.4 Basic salaries for teachers shall be paid in twenty-six (26) payments. Basic salaries for teachers shall be paid in twenty-six (26) payments in a given calendar year. Exceptions may be made with the approval of the Cash Flow Committee. A teacher may receive the balance due on his contract with the first scheduled paycheck in July by written notice to the Business Office by May 1. If May 1 occurs on a day that school is not in session, the deadline shall be the next regular school day. A teacher who makes this election shall continue each year to receive the balance due on his contract with the first scheduled paycheck in July unless he notifies the Business Office by May 1 that he prefers to be paid in twenty-six (26) payments. Teachers will be notified by the Cash Flow Committee of the Xxxxxxx Teachers’ Federation prior to June 1 in the event the balance on teachers’ contracts due on the first scheduled paycheck in July cannot be paid. 11.5 New teachers will receive one half (½) of their first pay one payroll in advance and the remaining one half (½) on the next pay date. 11.6 Effective January 1, 2009, teacher pay will be issued via direct deposit only. 11.7 The Superintendent may approve additional compensation for individual teachers who have been authorized by the Superintendent to perform additional work assignments. 11.8 Payroll deductions for teachers shall be made as required by law or as mutually agreed to by the parties. Teachers may authorize deductions for tax-sheltered annuities during open enrollment periods of the carrier companies involved. 11.9 Deductions for daily absences not covered by provisions in the Contract shall be made at the same rate as earned. 11.10 Effective January 1, 1993, the Board shall pay directly to the Indiana State Teachers Retirement Fund each teacher’s three percent (3%) contribution to the fund. 11.11 The parties recognize that the salaries which appear on Regular Teacher’s Contracts and Teacher’s Temporary Contracts will be inaccurate whenever a salary increase is approved after these contracts have been executed. At the time of a teacher’s retirement, the Employer will review these contracts and, when necessary, revise the contracts for the five (5) years of service before retirement in which the teacher’s annual compensation was highest so they accurately reflect the sums which the teacher earned in each of those five (5) years. 11.12 The parties recognize that students are entitled to be taught by fully qualified teachers, while at the same time recognizing a professional responsibility to assist in the preparation of student teachers. Therefore, supervision by a teacher of a student teacher shall be voluntary. No teacher should serve as a supervising teacher more than one-half (1/2) of the total teaching time each year. This provision was not bargained and has been included for informational purposes only. Should 11.13 If the Employer determines that any committee should continue its work during the summer, teachers belonging to the committee performing such services shall be paid on the same basis and in the same manner as summer school teachers. If the Employer determines that professional development should occur in the summer, specific teachers invited to participate shall be paid on the same basis as summer school teachers.

  • Monthly Salary The words “monthly salary” when used in this Agreement shall mean: (Bi-weekly pay at regular rate of pay times 26.1) divided by 12 = monthly salary

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