IMPORTANT. If you opt to receive dental services that are not covered services under this Plan, a participating dental Participating Dentist may charge you his or her usual and customary rate for those services. Prior to providing a patient with dental services that are not a covered benefit, the dentist should provide the patient with a treatment plan that includes each anticipated service. If you would like more information about dental coverage options, you may call member services at 0-000-000-0000 or your insurance broker. To fully understand your coverage, you may wish to carefully review this evidence of coverage document.
Appears in 26 contracts
Samples: Group Subscriber Agreement, Group Subscriber Agreement, Group Subscriber Agreement
IMPORTANT. If you opt to receive dental services that are not covered services under this Plan, a participating dental Participating Dentist may charge you his or her usual and customary rate for those services. Prior to providing a patient with dental services that are not a covered benefit, the dentist should provide the patient with a treatment plan that includes each anticipated service. If you would like more information about dental coverage options, you may call member services at 0-000-000-0000 or your insurance broker. To fully understand your coverage, you may wish to carefully review this evidence of coverage document.patient
Appears in 6 contracts
Samples: Individual Subscriber Agreement, Individual Subscriber Agreement, Individual Subscriber Agreement
IMPORTANT. If you opt to receive dental services that are not covered services under this Plan, a participating dental Participating Dentist provider may charge you his or her usual and customary rate for those services. Prior to providing a patient with dental services that are not a covered benefit, the dentist should provide to the patient with a treatment plan that includes each anticipated service to be provided and the estimated cost of each service. If you would like more information about dental coverage options, you may call member services customer service at 01-000800-000-0000 248- 2341 or your insurance broker. To fully understand your coverage, you may wish to should carefully review this evidence of coverage documentAgree- ment.
Appears in 4 contracts
Samples: Dental Ppo Plan 1000 for Medicare Supplement Subscribers, Dental Ppo Plan 1000, Dental Ppo Plan 1500
IMPORTANT. If you opt to receive dental services that are not covered services under this Plan, a participating dental Participating Dentist provider may charge you his or her usual and customary rate for those services. Prior to providing a patient with dental services that are not a covered benefit, the dentist should provide the patient with a treatment plan that includes each anticipated service. If you would like more information about dental coverage options, you may call member services at 0-000-000-0000 or your insurance broker. To fully understand your coverage, you may wish to carefully review this evidence of coverage document.
Appears in 1 contract
Samples: Individual Subscriber Agreement
