HOW YOUR COVERED DENTAL SERVICES ARE PAID Sample Clauses

HOW YOUR COVERED DENTAL SERVICES ARE PAID. Payments we make to you are personal and you cannot transfer or assign any of your right to receive payments under this agreement to another person or organization. Our allowance is the maximum amount to be paid for a covered dental service. We will not be responsible for more than the allowance even if more than one dentist renders a covered dental service. You must file all claims within one benefit year of the date you receive a covered dental service. Member submitted claims that arrive after this deadline are invalid unless: • it was not reasonably possible for you to file your claim prior to the filing deadline; AND • you file your claim as soon as possible but no later than ninety (90) calendar days after the filing deadline elapses (unless you are legally incapable). Our payments to you or the dentist fulfill our responsibility under this agreement. In accordance with Rhode Island General Law § 27-20-49, benefits may be assigned and with your written consent our payments can be made to a non-network dentist. Your benefits, however, are personal to you and cannot be assigned, in whole or in part, to another person or organization. Network dentist file claims for you and must do so within one year of providing a covered dental service to you. Non-network dentist may or may not file claims for you. If the non-network dentist does not file the claim on your behalf, you will need to file the claim yourself. To file a claim, please send us an itemized bill including the following: • patient's name; • your member identification number; • the name, address, and telephone number of the dentist who performed the service; • date and description of the service; AND • charge for that service. Please mail the claim to: Blue Cross & Blue Shield of Rhode Island Attention: Blue Cross Dental P. O. Box 219 Providence, RI 02901-0219
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HOW YOUR COVERED DENTAL SERVICES ARE PAID. Payments we make to you are personal and you cannot transfer or assign any of your right to receive payments under this agreement to another person or organization. Our allowance is the maximum amount to be paid for a covered dental service. We will not be responsible for more than the allowance even if more than one dentist renders a covered dental service.
Sample 1

Related to HOW YOUR COVERED DENTAL SERVICES ARE PAID

  • Vision Care Effective July 1, 2000, the District shall provide all full-time employees and their dependents with Vision Service Plan (VSP) Plan C. This plan shall provide for a comprehensive exam and new lenses every 12 months, and new frames every 12 months. All other services will be pursuant to the standard VSP plan description, except that it will reimburse up to $50 for examinations by non-panel providers. There shall be a $10 annual deductible on materials only. In addition, the following vision plan enhancements shall take place effective July 1, 2000: $60 wholesale frame allowance; computer glasses; progressive lenses, tints, and UV coatings.

  • Vision Care Services For purposes of coordination of benefits, vision care services covered under other plans are not considered an allowable expense, as defined in the Coordination of Benefits and Subrogation in Section 7.

  • Dental Services The following dental services are not covered, except as described under Dental Services in Section 3: • Dental injuries incurred as a result of biting or chewing. • General dental services including, but not limited to, extractions including full mouth extractions, prostheses, braces, operative restorations, fillings, frenectomies, medical or surgical treatment of dental caries, gingivitis, gingivectomy, impactions, periodontal surgery, non-surgical treatment of temporomandibular joint dysfunctions, including appliances or restorations necessary to increase vertical dimensions or to restore the occlusion. • Panorex x-rays or dental x-rays. • Orthodontic services, even if related to a covered surgery. • Dental appliances or devices. • Preparation of the mouth for dentures and dental or oral surgeries such as, but not limited to, the following: o apicoectomy, per tooth, first root; o alveolectomy including curettage of osteitis or sequestrectomy; o alveoloplasty, each quadrant; o complete surgical removal of inaccessible impacted mandibular tooth mesial surface; o excision of feberous tuberosities; o excision of hyperplastic alveolar mucosa, each quadrant; o operculectomy excision periocoronal tissues; o removal of partially bony impacted tooth; o removal of completely bony impacted tooth, with or without unusual surgical complications; o surgical removal of partial bony impaction; o surgical removal of impacted maxillary tooth; o surgical removal of residual tooth roots; and o vestibuloplasty with skin/mucosal graft and lowering the floor of the mouth. Dialysis Services • The following dialysis services received in your home: o installing or modifying of electric power, water and sanitary disposal or charges for these services; o moving expenses for relocating the machine; o installation expenses not necessary to operate the machine; and o training in the operation of the dialysis machine when the training in the operation of the dialysis machine is billed as a separate service. • Dialysis services received in a physician’s office.

  • Vision Care Plan The County agrees to provide a Vision Care Plan for all employees and dependents. The Plan will be the Vision Service Plan - Plan A with benefits at 12/12/24 month intervals and with twenty dollar ($20.00) deductible for examinations and twenty dollar ($20.00) deductible for materials. The County will fully pay the monthly premium for the employee and dependents and pick up inflationary costs during the term of the Agreement.

  • Dental Services Plan The Corporation agrees to provide a Dental Plan for the benefit of Regular Full-Time Employees who have completed six (6) months of continuous service and Temporary Full-Time Employees who have completed twelve (12) months of continuous service which provides for the following services:

  • Special Services Should the Trust have occasion to request the Adviser to perform services not herein contemplated or to request the Adviser to arrange for the services of others, the Adviser will act for the Trust on behalf of the Fund upon request to the best of its ability, with compensation for the Adviser's services to be agreed upon with respect to each such occasion as it arises.

  • Prevention Care Services and Early Detection Services See Prevention and Early Detection Services section for details. 0% Not Covered Private Duty Nursing Services* Must be performed by a certified home health care agency. 0% - After deductible Not Covered

  • New Financial Services Each Party shall permit a financial service supplier of the other Party to provide any new financial service of a type similar to those services that the Party would permit its own financial service suppliers to provide under its domestic law in like circumstances. A Party may determine the juridical form through which the service may be provided and may require authorisation for the provision of the service. Where such authorisation is required, a decision shall be made within a reasonable time and the authorisation may only be refused for prudential reasons.

  • COVERED HEALTHCARE SERVICES This section describes covered healthcare services. This plan covers services only if they meet all of the following requirements: • Listed as a covered healthcare service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered healthcare service under this plan. • Medically necessary, consistent with our medical policies and related guidelines at the time the services are provided. • Not listed in Exclusions Section. • Received while a member is enrolled in the plan. • Consistent with applicable state or federal law. We review medical necessity in accordance with our medical policies and related guidelines. Our medical policies can be found on our website. Our medical policies are written to help administer benefits for the purpose of claims payment. They are made available to you for informational purposes and are subject to change. Medical policies are not meant to be used as a guide for your medical treatment. Your medical treatment remains a decision made by you with your physician. If you have questions about our medical policies, please call Customer Service. When a new service or drug becomes available, when possible, we will review it within six (6) months of one of the events described below to determine whether the new service or drug will be covered: • the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; • final Food and Drug Administration (FDA) approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria above; and • generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). During the review period, new services and drugs are not covered. For all covered healthcare services, please see the Summary of Medical Benefits and the Summary of Pharmacy Benefits to determine the amount that you pay and any benefit limits.

  • Financial Services The aim of cooperation shall be to achieve closer common rules and standards in areas including the following:

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