Common use of Predetermination of Benefits Clause in Contracts

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. 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 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 insurance company will notify both you the employee and your the dentist of the estimated payment.

Predetermination of Benefits. If dental expenses in connection with a course of treatment planned by a dentist for a covered family member will exceed two hundred dollars ($200), the proposed course of treatment should be filed with and approved by the Insurance Company 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 insurance company will notify both you the employee and your the dentist of the estimated payment.