Common use of Predetermination of Benefits Clause in Contracts

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 charges for a planned course of treatment by a licensed practitioner would exceed $300.300.00, 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 malocclusionor

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 malocclusionor

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