Overview of Benefits Sample Clauses

Overview of Benefits. This information will help you understand how this dental plan works and how to make it work best for you. a. What is the DeltaCare USA Plan? The DeltaCare USA plan provides Pediatric Benefits through a network of Contract Dentists in the state of Florida. These Dentists are screened to ensure that our standards of quality, access and safety are maintained. The network is composed of established dental professionals. When you visit your assigned Contract Dentist, you pay only the applicable Copayment for Benefits. There are no deductibles, lifetime maximums or claim forms.
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Overview of Benefits. Alliance Options Select (AOS) is a modular annual health insurance plan for individuals, families and companies. There are four schemes with different levels of benefits. The benefits of the plan are designed to assist with the member’s access to, and use of, appropriate medical services for the maintenance of good health and for the treatment of disease, illness and injury. These benefits are detailed under the “What is Covered?” section of this booklet.
Sample 1
Overview of Benefits. Following is a brief overview of the proposed Xxxxxx Creek Health Care PPO Plan benefits beginning July 1, 2006. associated with physical examination once per calendar year when performed as routine screening. • Chemical profile • Complete blood count or any of its components • Urinalysis • Chest x-ray • EKG
Sample 1
Overview of Benefits. Following is a brief overview of the proposed Xxxxxx Creek Health Care PPO Plan benefits. • Chemical profile • Complete blood count or any of its components • Urinalysis • Chest x-ray • EKG Complete Vision Examination $ 64.00 Single Vision Lenses (each pair) $ 84.50 Bifocal Lenses (each pair) $ 96.00 Trifocal Lenses (each pair) $120.00 Progressive Lenses (each pair) $200.00 Contact Lenses $200.00 Frames – Standard Type $ 65.00 The above services/items are available as follows: Vision Examination Once every 12 months Frames Once every 12 months Lenses Once every 12 months Dental Benefit Program for those who DO NOT have other dental coverage (non COB) BASIC SERVICES 80% of R&C* Basic Services Include Services Such As: Examinations Diagnostic X-Rays Cleanings (Prophlaxis) Oral Surgery and Anesthetics Fillings Root Canals (Endodontics) Fluoride Treatment (to age 18) Periodontics Lifetime Deductible $0 Major Services Include Such Services As: Inlays Dentures (Full and Partial) Crowns and/or Bridges Crown and/or Bridge Repair Annual Deductible $0 Combined Annual Maximum $1300 per year/per person total benefit (to age 19) Deductible $0 Lifetime Maximum $1600 per person Dental Benefit Program for those who DO have other dental coverage (COB) BASIC SERVICES 50% of R&C* Basic Services Include Services Such As: Examinations Diagnostic X-Rays Cleanings (Prophlaxis) Oral Surgery and Anesthetics Fillings Root Canals (Endodontics) Fluoride Treatment (to age 18) Periodontics Lifetime Deductible $0 Major Services Include Such Services As: Inlays Dentures (Full and Partial) Crowns and/or Bridges Crown and/or Bridge Repair Annual Deductible $0 Combined Annual Maximum $1300 per year/per person total benefit (to age 19) Deductible $0 Lifetime Maximum $1600 per person *R&C means reasonable and customary. It is hereby agreed and stipulated by and between the Xxxxxx Creek Board of Education and the Xxxxxx Creek Education Association that on the first scheduled day of school each elementary principal will present a tentative daily schedule to the teaching staff for their input. The schedule will include all reasonable efforts to schedule first and second grade art, music, and physical education in the afternoon and provide as large of a block of uninterrupted morning class time for these grades as possible. After consultation with the staff, the final schedule will be determined. Special education teachers and support staff will schedule their students in consultation with the cl...
Sample 1

Related to Overview of Benefits

  • Duration of Benefits Eligibility for Income Protection benefits will cease upon the earliest of the following dates: 1.09.01 the date the member is no longer disabled from performing the duties of their regular position, or any alternative employment made available to the member by the City. 1.09.02 the date the member's Income Protection benefits have been expended. 1.09.03 the date the member dies.

  • Coordination of Benefits i. Delta Dental coordinates the dental Benefits under this dental plan with your benefits under any other group or pre-paid plan or insurance plan designed to fully integrate with other plans. If this plan is the “primary” plan, Delta Dental will not reduce Benefits. If this plan is the “secondary” plan, Delta Dental may reduce Benefits so that the total benefits paid or provided by all plans do not exceed 100% of total allowable expense. ii. How does Delta Dental determine which Plan is the “primary” plan? 1) The plan covering the Enrollee as an employee is primary over a plan covering the Enrollee as a dependent. 2) The plan covering the Enrollee as an employee is primary over a plan covering the insured person as a dependent; except that if the insured person is also a Medicare beneficiary, and as a result of the rule established by Title XVIII of the Social Security Act and implementing regulations, Medicare is: a) secondary to the plan covering the insured person as a dependent; and b) primary to the plan covering the insured person as other than a dependent (e.g. a retired employee), then the benefits of the plan covering the insured person as a dependent are determined before those of the plan covering that insured person as other than a dependent. 3) Except as stated in paragraph 4), when this plan and another plan cover the same child as a dependent of different persons, called parents: a) the benefits of the plan of the parent whose birthday falls earlier in a year are determined before those of the plan of the parent whose birthday falls later in that year; but b) if both parents have the same birthday, the benefits of the plan covering one parent longer are determined before those of the plan covering the other parent for a shorter period of time. c) However, if the other plan does not have the birthday rule described above, but instead has a rule based on the gender of the parent, and if, as a result, the plans do not agree on the order of benefits, the rule in the other plan determines the order of benefits. 4) In the case of a dependent child of legally separated or divorced parents, the plan covering the Enrollee as a dependent of the parent with legal custody or as a dependent of the custodial parent’s spouse (i.e. step-parent) will be primary over the plan covering the Enrollee as a dependent of the parent without legal custody. If there is a court decree establishing financial responsibility for the health care expenses with respect to the child, the benefits of a plan covering the child as a dependent of the parent with such financial responsibility will be determined before the benefits of any other policy covering the child as a dependent child. 5) If the specific terms of a court decree state that the parents will share joint custody without stating that one of the parents is responsible for the health care expenses of the child, the plans covering the child will follow the order of benefit determination rules outlined in paragraph 3). 6) The benefits of a plan covering an insured person as an employee who is neither laid-off nor retired are determined before those of a plan covering that insured person as a laid-off or retired employee. The same would hold true if an insured person is a dependent of a person covered as a retiree or an employee. If the other plan does not have this rule, and if, as a result, the plans do not agree on the order of benefits, this rule 6) is ignored. 7) If an insured person whose coverage is provided under a right of continuation pursuant to federal or state law also is covered under another plan, the following will be the order of benefit determination. a) First, the benefits of a plan covering the insured person as an employee (or as that insured person’s dependent). b) Second, the benefits under the continuation coverage. c) If the other plan does not have the rule described above, and if, as a result, the plans do not agree on the order of benefits, this rule 7) is ignored. 8) If none of the above rules determines the order of benefits, the benefits of the plan covering an employee longer are determined before those of the plan covering that insured person for the shorter term. 9) When determination cannot be made in accordance with the above for Pediatric Benefits, the benefits of a plan that is a medical plan covering dental as a benefit will be primary to a dental only plan.

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