EXCLUSIONS FOR PEDIATRIC BENEFITS Sample Clauses

EXCLUSIONS FOR PEDIATRIC BENEFITS. Only American Dental Association procedure codes are covered under this section. Except as specifically provided in this Benefit Plan and the Schedule of Dental Benefits, no coverage will be provided under this section for services, supplies or charges that are: 1. Started prior to the Member’s Effective Date or after the Termination Date of coverage under this Benefit Plan, including, but not limited to multi-visit procedures such as endodontics, crowns, bridges, inlays, onlays, and dentures. 2. For house or hospital calls for dental services and for hospitalization costs (e.g., facility-use fees). 3. The responsibility of any federal or state workers’ compensation laws and/or related programs including, but not limited to, the Xxxxx Act, Federal Employers Liability Act, Federal Employees Compensation Act, Xxxxxxxxx and Harbor Workers’ Compensation Act, Black Lung Benefits Act, Energy Employees Occupational Illness Compensation Program, and Title 23 of the Louisiana Revised Statutes, whether or not coverage under such laws or programs is actually in force, the responsibility of employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. UCD’s benefits would be in excess to the third-party benefits and therefore, UCD would have right of recovery for any benefits paid in excess. Our right of Subrogation is secondary to the right of the covered insured to be fully compensated for his damages. 4. Cosmetic in nature as determined by UCD (for example but not limited to, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).
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EXCLUSIONS FOR PEDIATRIC BENEFITS. Only American Dental Association procedure codes are covered under this section. Except as specifically provided in this Benefit Plan and the Schedule of Dental Benefits, no coverage will be provided under this section for services, supplies or charges that are: 1. Started prior to the Member’s Effective Date or after the Termination Date of coverage under this Benefit Plan, including, but not limited to multi-visit procedures such as endodontics, crowns, bridges, inlays, onlays, and dentures. 2. For house or hospital calls for dental services and for hospitalization costs (e.g. facility -use fees). 3. The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. UCD’s benefits would be in excess to the third-party benefits and therefore, UCD would have right of recovery for any benefits paid in excess. Our right of Subrogation is secondary to the right of the covered insured to be fully compensated for his damages. 4. For prescription and non-prescription drugs, vitamins or dietary supplements. 5. Cosmetic in nature as determined by UCD (for example but not limited to, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).
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EXCLUSIONS FOR PEDIATRIC BENEFITS. ‌ For any claims submitted to UCD by the Member or on behalf of the Member in excess of fiftee n‌
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EXCLUSIONS FOR PEDIATRIC BENEFITS. Only American Dental Association procedure codes are covered under this section. Except as specifically provided in this Contract and the Schedule of Dental Benefits, no coverage will be provided under this section for services, supplies or charges that are: Started prior to the Member’s Effective Date or after the Termination Date of coverage under this Contract, including, but not limited to multi-visit procedures such as endodontics, crowns, bridges, inlays, onlays, and dentures. For house or hospital calls for dental services and for hospitalization costs (e.g. facility -use fees). The responsibility of any federal or state workers’ compensation laws and/or related programs including, but not limited to, the Xxxxx Act, Federal Employers Liability Act, Federal Employees Compensation Act, Xxxxxxxxx and Harbor Workers’ Compensation Act, Black Lung Benefits Act, Energy Employees Occupational Illness Compensation Program, and Title 23 of the Louisiana Revised Statutes, whether or not coverage under such laws or programs is actually in force, the responsibility of employer’s liability insurance, or for treating any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. Benefits would be more than the third-party Benefits and therefore, We would have right of recovery for any Benefits paid in excess. Our right of Subrogation is contingent on the right of the covered insured to be fully compensated as determined by settlement of the parties in any claim for recovery or legal action, a ruling in a legal action by a court of competent jurisdiction, or a judgment following a trial . Cosmetic in nature as determined by UCD (for example but not limited to, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures). Maxillofacial prosthetics. For congenital mouth malformations or skeletal imbalances (for example, but not limited to, treatment related to cleft lip or cleft palate, disharmony of facial bone, or required as the result of orthognathic surgery including orthodontic treatment). Coverage for Cleft Lip and Cleft Palate Services is provided in the Other Covered Services, Supplies or Equipment Article of this Contract. For diagnostic services and treatment of jaw joint problems by any method unless specifically covered under the Certificate. Examples of these jaw joint problems are Temporomandibular Joint (TMJ) Disorders or other conditions of the joint linking the jaw...
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EXCLUSIONS FOR PEDIATRIC BENEFITS. ‌ 1. Started prior to the Member’s Effective Date or after the Termination Date of coverage under this Contract, including, but not limited to multi-visit procedures such as endodontics, crowns, bridges, inlays, onlays, and dentures. 2. For house or hospital calls for dental services and for hospitalization costs (e.g. facility -use fees). 3. The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. UCD’s Benefits would be in excess to the third-party Benefits and therefore, UCD would have right of recovery for any Benefits paid in excess. Our right of Subrogation is secondary to the right of the covered insured to be fully compensated for his damages. 4. For prescription and non-prescription drugs, vitamins or dietary supplements. 5. Cosmetic in nature as determined by UCD (for example but not limited to, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).
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EXCLUSIONS FOR PEDIATRIC BENEFITS. ‌ 7. 8. 11.
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EXCLUSIONS FOR PEDIATRIC BENEFITS. Only American Dental Association procedure codes are covered under this section. Except as specifically provided in this Contract and the Schedule of Dental Benefits, no coverage will be provided under this section for services, supplies or charges that are: 1. Started prior to the Member’s Effective Date or after the Termination Date of coverage under this Contract, including, but not limited to multi-visit procedures such as endodontics, crowns, bridges, inlays, onlays, and dentures. 2. For house or hospital calls for dental services and for hospitalization costs (e.g. facility-use fees). 3. The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. UCD’s Benefits would be in excess to the third-party Benefits and therefore, UCD would have right of recovery for any Benefits paid in excess. 4. For prescription and non-prescription drugs, vitamins or dietary supplements. 5. Cosmetic in nature as determined by UCD (for example but not limited to, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).
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Related to EXCLUSIONS FOR PEDIATRIC BENEFITS

  • Public Benefits ‌ 5.1 Developer to provide Public Benefits‌ The Developer must, at its cost and risk, provide the Public Benefits to the City in accordance with this document.

  • Health Benefits For the eighteen (18) month period following the Termination Date, provided that Executive is eligible for, and timely elects COBRA continuation coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation coverage under the Company’s group health plan for Executive and, where applicable, her spouse and dependents, at the level in effect as of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion of the applicable premiums that Executive would have paid had she remained employed during the such eighteen (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)). The reimbursements described herein shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretion.

  • Exclusions from General Release Excluded from the Release are any claims or rights that cannot be waived by law, as well as Executive’s right to file a charge with an administrative agency or participate in any agency investigation. Executive is, however, waiving the right to recover any money in connection with a charge or investigation. Executive is also waiving the right to recover any money in connection with a charge filed by any other individual or by the Equal Employment Opportunity Commission or any other federal or state agency.

  • Specific Benefits Without limiting the generality of Section 3.3, the Executive shall be entitled to paid vacation of not less than the greater of (a) 20 business days per year or (b) the number of paid business vacation days provided to other senior executives of the Company (to be taken at reasonable times in accordance with the Company’s policies). Any accrued vacation not taken during any year may be carried forward to subsequent years; provided, that the Executive may not carry forward more than ten business days of unused vacation in any one year.

  • Extended Health Benefits The extended health benefits coverage for CUPE and Fire will be amended to include:

  • Retiree Health Benefits 1. There is currently in effect a retiree health benefit program for retired members of LACERS under LAAC Division 4, Chapter 11. All covered employees who are members of LACERS, regardless of retirement tier, shall contribute to LACERS four percent (4%) of their pre-tax compensation earnable toward vested retiree health benefits as provided by this program. The retiree health benefit available under this program is a vested benefit for all covered employees who make this contribution, including employees enrolled in LACERS Tier 3. 2. With regard to LACERS Tier 1, as provided by LAAC Section 4.1111, the monthly Maximum Medical Plan Premium Subsidy, which represents the Kaiser 2-party non-Medicare Part A and Part B premium, is vested for all members who made the additional contributions authorized by LAAC Section 4.1003(c). 3. Additionally, with regard to Tier 1 members who made the additional contribution authorized by LAAC Section 4.1003(c), the maximum amount of the annual increase authorized in LAAC Section 4.1111(b) is a vested benefit that shall be granted by the LACERS Board. 4. With regard to LACERS Tier 3, the Implementing Ordinance shall provide that all Tier 3 members shall contribute to LACERS four percent (4%) of their pre-tax compensation earnable toward vested retiree health benefits, and shall amend LAAC Division 4, Chapter 11 to provide the same vested benefits to all Tier 3 members as currently are provided to Tier 1 members who make the same four percent (4%) contribution to LACERS under the retiree health benefit program. 5. The entitlement to retiree health benefits under this provision shall be subject to the rules under LAAC Division 4, Chapter 11 in effect as of the effective date of this provision, and the rules that shall be placed into LAAC Division 4, Chapters 10 and 11, with regard to Tier 3, by the Implementing Ordinance. 6. As further provided herein, the amount of employee contributions is subject to bargaining in future MOU negotiations. 7. The vesting schedule for the Maximum Medical Plan Premium Subsidy for employees enrolled in LACERS Tier 1 and LACERS Tier 3 shall be the same. 8. Employees whose Health Service Credit, as defined in LAAC Division 4, Chapter 11, is based on periods of part-time and less than full-time employment, shall receive full, rather than prorated, Health Service Credit for periods of service. The monthly retiree medical subsidy amount to which these employees are entitled shall be prorated based on the extent to which their service credit is prorated due to their less than full time status.

  • PORTABILITY OF BENEFITS The following benefits are portable: 6.01 Accumulated income protection benefits/sick leave credits. 6.02 Length of employment applicable to rate at which vacation is earned. 6.03 Length of employment applicable to pre-retirement leave. NOTE: Deer Lodge Centre limits payment of pre-retirement leave to service acquired since April 1, 1983. Incoming employees would retain original service date for this purpose. 6.04 Length of employment for the purpose of qualifying to join benefit plans, e.g., two (2) year pension requirement.

  • Standard Benefits During the Employment Period, Executive shall be entitled to participate in all employee benefit plans and programs, including paid vacations, generally available to other similarly situated Company executives, subject to the terms and conditions of the applicable plans.

  • Synopsis and Benefit to Xxxxxxx County The Agreement continues the contractual relationship between the Oregon State Marine Board and Xxxxxxx County through its Sheriff’s Office. The Sheriff’s Office will be reimbursed for marine law enforcement patrols, boater education, and boat inspections conducted throughout the County.

  • Third Party Administrators for Defined Contribution Plans 2.1 The Fund may decide to make available to certain of its customers, a qualified plan program (the “Program”) pursuant to which the customers (“Employers”) may adopt certain plans of deferred compensation (“Plan or Plans”) for the benefit of the individual Plan participant (the “Plan Participant”), such Plan(s) being qualified under Section 401(a) of the Code and administered by TPAs which may be plan administrators as defined in the Employee Retirement Income Security Act of 1974, as amended. 2.2 In accordance with the procedures established in Schedule 2.1 entitled “Third Party Administrator Procedures,” as may be amended by the Transfer Agent and the Fund from time to time (“Schedule 2.1”), the Transfer Agent shall: (a) Treat Shareholder accounts established by the Plans in the name of the Trustees, Plans or TPAs, as the case may be, as omnibus accounts; (b) Maintain omnibus accounts on its records in the name of the TPA or its designee as the Trustee for the benefit of the Plan; and (c) Perform all Services under Section 1 as transfer agent of the Funds and not as a record-keeper for the Plans. 2.3 Transactions identified under Sections 1 and 2 of this Agreement shall be deemed exception services (“Exception Services”) when such transactions: (a) Require the Transfer Agent to use methods and procedures other than those usually employed by the Transfer Agent to perform transfer agency and recordkeeping services; (b) Involve the provision of information to the Transfer Agent after the commencement of the nightly processing cycle of the TA2000 System; or (c) Require more manual intervention by the Transfer Agent, either in the entry of data or in the modification or amendment of reports generated by the TA2000 System, than is normally required.

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