Predetermination of Benefits. If charges for a planned course of treatment by a licensed dentist would exceed $300.00, proposed details and x-rays should be submitted to the Plan Administrator for approval. Failure to do so may result in a payment of a lesser benefit amount because of the difficulty in determining the need for such treatment after it has been provided. Dental x-rays will be promptly returned to the dentist.
Predetermination of Benefits. If a course of treatment can reasonably be expected to involve Covered Dental Expenses of $200.00 or more, a description of the procedures to be performed and an estimate of the dentist's charges must be filed with the prepayment agency prior to the commencement of the course of treatment. The prepayment agency will notify the employee and the dentist of the benefits certified as payable based upon such course of treatment. In determining the amount of benefits payable, consideration will be given to alternate procedures, services, or courses of treatment that may be performed for the dental condition concerned in order to accomplish the desired result. The amount included as certified dental expenses will be the appropriate amount as provided in Sections III and IV, determined in accordance with the limitations set forth in Section VI. If a description of the procedures to be performed and an estimate of the dentist's charges are not submitted in advance, the prepayment agency reserves the right to make a determination of benefits payable taking into account alternate procedures, services or courses of treatment, based on accepted standards of dental practice. To the extent verification of Covered Dental Expenses cannot reasonably be made by the prepayment agency, the benefits for the course of treatment may be for a lesser amount than would otherwise have been payable. This predetermination requirement will not apply to courses of treatment under $200.00 or to emergency treatment, routine oral examinations, x rays, prophylaxis and fluoride treatments.
Predetermination of Benefits. If charges for a planned course of treatment by a licensed dentist would exceed $300, proposed details and x-rays should be submitted to the Plan Administrator for approval. Failure to do so may result in payment of a lesser benefit amount because of the difficulty in determining the need for such treatment after it has been provided. Dental x-rays will be promptly returned to the dentist. Limitations No amount will be paid for charges for: - Dental care which is cosmetic; - Completion of claim forms; - Broken appointments; - Dental care covered under a medical plan provided by an employer or government; - Which, in the absence of coverage, there would be no charge; - Stainless steel crowns on permanent teeth; - Oral hygiene instruction or nutritional counselling; - Protective athletic appliances; - Prostheses, including crowns and bridgework, and the fitting thereof which were ordered while the person was not covered, or which were ordered while the person was covered but which were finally installed or delivered after this benefit is discontinued; - A full mouth reconstruction, for a vertical dimension correction, or for diagnosis or correction of a temporomandibular joint dysfunction; or - Replacement of lost or stolen appliances.
Predetermination of Benefits. If charges for a planned course of treatment by a licensed practitioner would exceed $300., proposed details and x-rays should be submitted to Maritime Life for approval. Failure to do so may result in payment of a lesser benefit amount because of the difficulty in determining the need for such treatment after it has been provided. Dental x-rays will be promptly returned to the dentist. Course of treatment means one or more services rendered by one or more dentists for the correction of a dental condition diagnosed as a result of an oral exam starting on the date the first service to correct such condition is rendered. No amount will be paid for charges for: . dental care which is cosmetic; . completion of claim forms; . broken appointments; . dental care covered under a medical plan provided by an employer or government which, in the absence of insurance, there would be no charge; . stainless steel crowns on permanent teeth; . oral hygiene instruction or nutritional counselling; . protective athletic appliances; . prostheses, including crowns and bridgework, and the fitting thereof which were ordered while the person was not insured, or which were ordered while the person was insured but which were finally installed or delivered after this benefit is discontinued or more than 31 days after termination of insurance for any other reasons; . a full mouth reconstruction, for a vertical dimension correction, or for diagnosis or correction of a temporomandibular joint dysfunction; . replacement of a lost or stolen prosthesis; or . orthodontic treatment or correction of malocclusion
Predetermination of Benefits. If other than brief and routine dental services are needed, an Attending Dentist’s Statement (claim form) listing the proposed services should be submitted to Delta Dental Plan of Ohio in advance of your dentist completing such services. The Predetermination of Benefits procedure will enable Delta Plan of Ohio to verify eligibility and state the amount of benefit payable by your program.
Predetermination of Benefits. If a course of treatment is expected to involve charges for dental services in certain categories of care such as Periodontics, Endodontics, Special Services, Prosthetic Services or Orthodontics of $300 or more, it is recommended that a description of the procedures to be performed, an estimate of the dentist's charges and an appropriate x-ray pertaining to the treatment, be filed by the dentist with us in writing, prior to the course of treatment.
Predetermination of Benefits. If dental expenses in connection with a course of treatment planned by a dentist for a covered family member will exceed $200, the proposed course of treatment should be filed with and approved by the Insurance Company prior to the commencement of treatment. Failure to file and obtain approval may result in benefits for the course of treatment in a lesser amount than would otherwise have been payable, because of the difficulty of determining the necessity for the types of services involved after they have been rendered. After reviewing the proposed course of treatment, the Insurance Company will notify both you and your dentist of the estimated payment.
Predetermination of Benefits. Predetermination of Benefits should be requested if the cost of the recommended treatment Plan exceeds Two Hundred Fifty Dollars ($250). DDPOK will issue an estimate of benefits regarding the Attending Dentist Statement (claim form) when satisfied that the patient is eligible for Benefits. The Predetermination will be for a maximum period of three hundred sixty-five (365) days from the date of Predetermination by DDPOK (one hundred eighty [180] for Periodontal procedures), but not longer than the period this Plan is in effect.
Predetermination of Benefits. If charges for a planned course of treatment by a licensed dentist would exceed proposed details and x-rays should be submitted to Life for approval. Failure to do so may result in payment of a lesser benefit amount because of the difficulty in determining the need for such treatment after it has been provided. Dental x-rays will be promptly returned to the dentist.
Predetermination of Benefits. If other than brief and routine dental services are needed, an Attending Dentist’s Statement (claim form) listing the proposed services should be submitted to Delta Dental Plan of Ohio in advance of your dentist completing such services. The Predetermination of Benefits procedure will enable Delta Plan of Ohio to verify eligibility and state the amount of benefit payable by your program.
D. The Board shall provide, at Board expense, a vision plan at least equal to the plan in effect February 20, 1998. The following vision care coverage shall be provided at Board expense for all members of the bargaining unit. Exam $10 co-payment Materials $10 co-payment Frequency Exam: once every 24 months Lenses: once every 24 months Frames: once every 24 months Subject to Plan limitations on participating providers. Eye Examination $35.00 Single Visions lens, up to $25.00 Bifocal Lens, up to $40.00 Trifocal Lens, up to $55.00 Lenticular Lens, up to $60.00 Frames, up to $35.00 Contact Lenses (necessary for vision correction) $210.00 Contact Lenses (elective) $105.00 Services obtained through non-participating providers are subject to the same co-payments and limitations as through Plan limitations on participating doctors.
