Common use of Important Telephone Numbers Clause in Contracts

Important Telephone Numbers. Always remember to carry Your Identification Card with you and present it to Your Dentist when receiving dental care services or supplies. Please remember that any time a change in Your family takes place it may be necessary for a new Identification Card to be issued to You. Upon receipt of the change in information, the Carrier will provide a new Identification Card. Predetermination of Benefits Predetermination is an estimate by BCBSTX of Your eligibility under the Plan for Dental benefits or covered Dental services, the amount of Your Deductible, Copayment or Coinsurance Amount related to Dental benefits or covered Dental services and the maximum benefit limits for Dental benefits or covered Dental services. If a Course of Treatment for non-emergency services can reasonably be expected to involve Eligible Dental Expenses in excess of $300, a description of the procedures to be performed and an estimate of the Dentist’s charge should be filed with BCBSTX prior to the commencement of treatment. BCBSTX may request copies of existing x-rays, photographs, models, and any other records used by the Dentist in developing the Course of Treatment. BCBSTX will review the reports and materials, taking into consideration alternative Courses of Treatment. BCBSTX will notify You and the Dentist of: • Your eligibility under the Plan; • Your Deductible, Copayment and Coinsurance Amount related to Dental benefits or covered Dental services; and • the maximum benefit limits for Dental benefits or covered Dental services. Benefit payments may be reduced based on any claims paid after a predetermination estimate is provided. Eligible Dental Expenses The Plan provides coverage for services and supplies that are considered Dentally Necessary. The benefit percentage to be applied to each category of service is shown on the DENTAL SCHEDULE OF COVERAGE. For benefits available for Eligible Dental Expenses, please refer to the DENTAL SCHEDULE OF COVERAGE in this Rider. Your benefits are calculated on a Calendar Year benefit period basis unless otherwise stated. At the end of a Calendar Year, a new benefit period starts for each Participant. Deductibles The benefits of the Plan will be available after satisfaction of the applicable Deductibles as shown on Your SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses will apply to the In- Network Deductible amount for an individual and family shown on the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Out-of-Pocket Maximum Your Eligible Dental Expenses payment obligation is applied to the out-of-pocket maximum as shown on Your SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses will apply to the In-Network out-of-pocket maximum amount for an individual and family shown on the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses applied toward satisfying the In- Network out-of-pocket maximum will only apply to the In-Network out-of-pocket maximum.

Important Telephone Numbers. Always remember to carry Your your Identification Card with you and present it to Your your Dentist when receiving dental care services or suppliesorsupplies. Please remember that any time a change in Your your family takes place it may be necessary for a new Identification Card to be issued to Youyou. Upon receipt of the change in information, the Carrier will provide a new Identification Card. Predetermination of Benefits Predetermination is an estimate by BCBSTX of Your your eligibility under the Plan for Dental benefits or covered Dental services, the amount of Your your Deductible, Copayment or Coinsurance Amount related to Dental benefits or covered Dental services and the maximum benefit limits for Dental benefits or covered Dental services. If a Course of Treatment for non-emergency services can reasonably be expected to involve Eligible Dental Expenses in excess of $300, a description of the procedures to be performed and an estimate of the Dentist’s charge should be filed with BCBSTX prior to the commencement of treatment. BCBSTX may request copies of existing x-rays, photographs, models, and any other records used by the Dentist in developing the Course of Treatment. BCBSTX will review the reports and materials, taking into consideration alternative Courses of Treatment. BCBSTX will notify You you and the Dentist of: • Your eligibility under the Plan; • Your your Deductible, Copayment and Coinsurance Amount related to Dental benefits or covered Dental services; and • the maximum benefit limits for Dental benefits or covered Dental services. Benefit payments may be reduced based on any claims paid after a predetermination estimate is provided. Eligible Dental Expenses The Plan provides coverage for services and supplies that are considered Dentally Necessary. The benefit percentage to be applied to each category of service is shown on the DENTAL SCHEDULE OF COVERAGE. For benefits available for Eligible Dental Expenses, please refer to the DENTAL SCHEDULE OF COVERAGE in this Rider. Your benefits are calculated on a Calendar Year benefit period basis unless otherwise stated. At the end of a Calendar Year, a new benefit period starts for each Participant. Deductibles The benefits of the Plan will be available after satisfaction of the applicable Deductibles as shown on Your your SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses will apply to the In- Network Deductible amount for an individual and family shown on the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Out-of-Pocket Maximum Your Eligible Dental Expenses payment obligation is applied to the out-of-pocket maximum as shown on Your your SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses will apply to the In-Network out-of-pocket maximum amount for an individual and family shown on the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses applied toward satisfying the In- Network out-of-pocket maximum will only apply to the In-Network out-of-pocket maximum.

Important Telephone Numbers. Always remember to carry Your your Identification Card with you and present it to Your your Dentist when receiving dental care services or supplies. Please remember that any time a change in Your your family takes place it may be necessary for a new Identification Card to be issued to Youyou. Upon receipt of the change in information, the Carrier will provide a new Identification Card. Predetermination of Benefits Predetermination is an estimate by BCBSTX of Your your eligibility under the Plan for Dental benefits or covered Dental services, the amount of Your your Deductible, Copayment or Coinsurance Amount related to Dental benefits or covered Dental services and the maximum benefit limits for Dental benefits or covered Dental services. If a Course of Treatment for non-emergency services can reasonably be expected to involve Eligible Dental Expenses in excess of $300, a description of the procedures to be performed and an estimate of the Dentist’s charge should be filed with BCBSTX prior to the commencement of treatment. BCBSTX may request copies of existing x-rays, photographs, models, and any other records used by the Dentist in developing the Course of Treatment. BCBSTX will review the reports and materials, taking into consideration alternative Courses of Treatment. BCBSTX will notify You you and the Dentist of: • Your eligibility under the Plan; • Your Deductible, Copayment and Coinsurance Amount related to Dental benefits or covered Dental services; and • the maximum benefit limits for Dental benefits or covered Dental services. Benefit payments may be reduced based on any claims paid after a predetermination estimate is provided. Eligible Dental Expenses The Plan provides coverage for services and supplies that are considered Dentally Necessary. The benefit percentage to be applied to each category of service is shown on the DENTAL SCHEDULE OF COVERAGE. For benefits available for Eligible Dental Expenses, please refer to the DENTAL SCHEDULE OF COVERAGE in this Rider. Your benefits are calculated on a Calendar Year benefit period basis unless otherwise stated. At the end of a Calendar Year, a new benefit period starts for each Participant. Deductibles The benefits of the Plan will be available after satisfaction of the applicable Deductibles as shown on Your SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses will apply to the In- Network Deductible amount for an individual and family shown on the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Out-of-Pocket Maximum Your Eligible Dental Expenses payment obligation is applied to the out-of-pocket maximum as shown on Your SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses will apply to the In-Network out-of-pocket maximum amount for an individual and family shown on the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses applied toward satisfying the In- Network out-of-pocket maximum will only apply to the In-Network out-of-pocket maximum.

Important Telephone Numbers. Always remember to carry Your your Identification Card with you and present it to Your your Dentist when receiving dental care services or supplies. Please remember that any time a change in Your your family takes place it may be necessary for a new Identification Card to be issued to Youyou. Upon receipt of the change in information, the Carrier will provide a new Identification Card. Predetermination of Benefits Predetermination is an estimate by BCBSTX of Your your eligibility under the Plan for Dental benefits or covered Dental services, the amount of Your your Deductible, Copayment or Coinsurance Amount related to Dental benefits or covered Dental services and the maximum benefit limits for Dental benefits or covered Dental services. If a Course of Treatment for non-emergency services can reasonably be expected to involve Eligible Dental Expenses in excess of $300, a description of the procedures to be performed and an estimate of the Dentist’s charge should be filed with BCBSTX prior to the commencement of treatment. BCBSTX may request copies of existing x-rays, photographs, models, and any other records used by the Dentist in developing the Course of Treatment. BCBSTX will review the reports and materials, taking into consideration alternative Courses of Treatment. BCBSTX will notify You you and the Dentist of: • Your eligibility under the Plan; • Your Deductible, Copayment and Coinsurance Amount related to Dental benefits or covered Dental services; and • the maximum benefit limits for Dental benefits or covered Dental services. Benefit payments may be reduced based on any claims paid after a predetermination estimate is provided. Eligible Dental Expenses The Plan provides coverage for services and supplies that are considered Dentally Necessary. The benefit percentage to be applied to each category of service is shown on the DENTAL SCHEDULE OF COVERAGE. For benefits available for Eligible Dental Expenses, please refer to the DENTAL SCHEDULE OF COVERAGE in this Rider. Your benefits are calculated on a Calendar Year benefit period basis unless otherwise stated. At the end of a Calendar Year, a new benefit period starts for each Participant. Deductibles The benefits of the Plan will be available after satisfaction of the applicable Deductibles as shown on Your your SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses will apply to the In- Network Deductible amount for an individual and family shown on the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Out-of-Pocket Maximum Your Eligible Dental Expenses payment obligation is applied to the out-of-pocket maximum as shown on Your your SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses will apply to the In-Network out-of-pocket maximum amount for an individual and family shown on the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses applied toward satisfying the In- Network out-of-pocket maximum will only apply to the In-Network out-of-pocket maximum.

Important Telephone Numbers. Always remember to carry Your your Identification Card with you and present it to Your your Dentist when receiving dental care services or supplies. Please remember that any time a change in Your your family takes place it may be necessary for a new Identification Card to be issued to Youyou. Upon receipt of the change in information, the Carrier will provide a new Identification Card. Predetermination of Benefits Predetermination is an estimate by BCBSTX of Your your eligibility under the Plan for Dental benefits or covered Dental services, the amount of Your your Deductible, Copayment or Coinsurance Amount related to Dental benefits or covered Dental services and the maximum benefit limits for Dental benefits or covered Dental services. If a Course of Treatment for non-emergency services can reasonably be expected to involve Eligible Dental Expenses in excess of $300, a description of the procedures to be performed and an estimate of the Dentist’s charge should be filed with BCBSTX prior to the commencement of treatment. BCBSTX may request copies of existing x-rays, photographs, models, and any other records used by the Dentist in developing the Course of Treatment. BCBSTX will review the reports and materials, taking into consideration alternative Courses of Treatment. BCBSTX will notify You you and the Dentist of: • Your eligibility under the Plan; • Your your Deductible, Copayment and Coinsurance Amount related to Dental benefits or covered Dental services; and • the maximum benefit limits for Dental benefits or covered Dental services. Benefit payments may be reduced based on any claims paid after a predetermination estimate is provided. Eligible Dental Expenses The Plan provides coverage for services and supplies that are considered Dentally Necessary. The benefit percentage to be applied to each category of service is shown on the DENTAL SCHEDULE OF COVERAGE. For benefits available for Eligible Dental Expenses, please refer to the DENTAL SCHEDULE OF COVERAGE in this Rider. Your benefits are calculated on a Calendar Year benefit period basis unless otherwise stated. At the end of a Calendar Year, a new benefit period starts for each Participant. Deductibles The benefits of the Plan will be available after satisfaction of the applicable Deductibles as shown on Your SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses will apply to the In- Network Deductible amount for an individual and family shown on the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Out-of-Pocket Maximum Your Eligible Dental Expenses payment obligation is applied to the out-of-pocket maximum as shown on Your SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses will apply to the In-Network out-of-pocket maximum amount for an individual and family shown on the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses applied toward satisfying the In- Network out-of-pocket maximum will only apply to the In-Network out-of-pocket maximum.

Important Telephone Numbers. Always remember to carry Your your Identification Card with you and present it to Your your Dentist when receiving dental care services or supplies. Please remember that any time a change in Your your family takes place it may be necessary for a new Identification Card to be issued to Youyou. Upon receipt of the change in information, the Carrier will provide a new Identification Card. Predetermination of Benefits Predetermination is an estimate by BCBSTX of Your your eligibility under the Plan for Dental benefits or covered Dental services, the amount of Your your Deductible, Copayment or Coinsurance Amount related to Dental benefits or covered Dental services and the maximum benefit limits for Dental benefits or covered Dental services. If a Course of Treatment for non-emergency services can reasonably be expected to involve Eligible Dental Expenses in excess of $300, a description of the procedures to be performed and an estimate of the Dentist’s charge should be filed with BCBSTX prior to the commencement of treatment. BCBSTX may request copies of existing x-rays, photographs, models, and any other records used by the Dentist in developing the Course of Treatment. BCBSTX will review the reports and materials, taking into consideration alternative Courses of Treatment. BCBSTX will notify You you and the Dentist of: •  Your eligibility under the Plan; • Your  your Deductible, Copayment and Coinsurance Amount related to Dental benefits or covered Dental services; and •  the maximum benefit limits for Dental benefits or covered Dental services. Benefit payments may be reduced based on any claims paid after a predetermination estimate is provided. Eligible Dental Expenses The Plan provides coverage for services and supplies that are considered Dentally Necessary. The benefit percentage to be applied to each category of service is shown on the DENTAL SCHEDULE OF COVERAGE. For benefits available for Eligible Dental Expenses, please refer to the DENTAL SCHEDULE OF COVERAGE in this Rider. Your benefits are calculated on a Calendar Year benefit period basis unless otherwise stated. At the end of a Calendar Year, a new benefit period starts for each Participant. Deductibles The benefits of the Plan will be available after satisfaction of the applicable Deductibles as shown on Your SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses will apply to the In- Network Deductible amount for an individual and family shown on the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Out-of-Pocket Maximum Your Eligible Dental Expenses payment obligation is applied to the out-of-pocket maximum as shown on Your SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses will apply to the In-Network out-of-pocket maximum amount for an individual and family shown on the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. Eligible Dental Expenses applied toward satisfying the In- Network out-of-pocket maximum will only apply to the In-Network out-of-pocket maximum.