COVERED DENTAL CARE SERVICES definition

COVERED DENTAL CARE SERVICES means any dental service, treatment, or procedure that we have determined is eligible for reimbursement under this plan. PREDETERMINATION is a procedure whereby you or your dentist sends us your treatment plan before treatment is rendered and we review to determine if a proposed treatment is covered under your plan. A predetermination is an estimate, not a guarantee of payment, and is based on your eligibility status and benefits at the time of the request. It is subject to change. In addition, predetermination also determines if a dental service is dentally necessary, or is medically necessary for an orthodontics service.
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COVERED DENTAL CARE SERVICES means any dental service, treatment, or procedure that we have determined is eligible for reimbursement under this agreement. Reimbursement for covered dental care services is always subject to our allowance and must be deemed dentally necessary. Covered Dental Care Services does not include the services of an anesthesiologist.
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COVERED DENTAL CARE SERVICES means any dental service, treatment, or procedure that we have determined is eligible for reimbursement under this plan. PREDETERMINATION is a procedure whereby your dentist sends us your treatment plan before treatment is rendered. Predeterminations are an estimate, not a guarantee of payment and are based on your eligibility status and benefits at the time the request is processed. It is subject to change.
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Examples of COVERED DENTAL CARE SERVICES in a sentence

  • The Maximum Benefit applies to: ALL COVERED DENTAL CARE SERVICES.


More Definitions of COVERED DENTAL CARE SERVICES

COVERED DENTAL CARE SERVICES means any service, treatment, or procedure which we have determined is eligible for reimbursement under this agreement. Reimbursement for covered dental services is always subject to you annual maximum benefit. DENTAL NECESSITY (DENTALLY NECESSARY) means that the dental services provided by a dentist to identify or treat your dental or oral health condition, upon review by Blue Cross & Blue Shield of Rhode Island, are: • consistent with the symptoms and appropriate and effective for the diagnosis, treatment, or care of the oral condition, disease, or injury for which it is prescribed or performed; • appropriate with regard to generally accepted standards of medical practice within the medical community, dental practice within the dental community, or scientific evidence; • not primarily for the convenience of the member, the member's family or dentist of such • the most appropriate in terms of type, amount, frequency, setting, duration, and level of service to the member’s diagnosis or condition which can safely be provided to the member. We will make a determination whether a dental service is dentally necessary based on our dental policies and related guidelines. You have the right to appeal our determination or to take legal action as described in Section 7.0. We may review dental necessity on a case-by-case basis. WE DETERMINE DENTAL NECESSITY SOLELY FOR PURPOSES OF CLAIMS PAYMENT IN ACCORDANCE WITH OUR DENTAL POLICIES AND RELATED GUIDELINES UNDER THIS AGREEMENT. DENTIST means any person duly licensed and registered to practice dentistry as defined in Section 5-31-1 of the General Laws of Rhode Island, as amended. This includes persons duly licensed under comparable laws of other states and countries if covered dental services are rendered at the time and place that comparable laws are effective. The services must be performed within the scope of the individual's license.
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Related to COVERED DENTAL CARE SERVICES

  • Foster care services means the provision of a full range of casework, treatment and community

  • Health care services means services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease.

  • PREVENTIVE CARE SERVICES means covered healthcare services performed to prevent the occurrence of disease as defined by the Affordable Care Act (ACA). See Preventive Care and Early Detection Services in Section 3. PRIMARY CARE PROVIDER (PCP) means, for the purpose of this plan, professional providers that are family practitioners, internists, and pediatricians. For the purpose of this plan, gynecologists, obstetricians, nurse practitioners, and physician assistants may be credentialed as PCPs. To find a PCP or check that your provider is a PCP, please use the “Find a Doctor” tool on our website or call Customer Service.

  • Personal care services means both physical assis- tance and/or prompting and supervising the performance of direct personal care tasks as determined by the resident's needs and does not include assistance with tasks performed by a licensed health professional.

  • Health care service means that service offered or provided by health care facilities and health care providers relating to the prevention, cure, or treatment of illness, injury, or disease.

  • Extended foster care services means residential and other

  • Home health care services means medical and nonmedical services, provided to ill, disabled or infirm persons in their residences. Such services may include homemaker services, assistance with activities of daily living and respite care services.

  • COVERED HEALTHCARE SERVICES means any service, treatment, procedure, facility, equipment, drug, device, or supply that we have reviewed and determined is eligible for reimbursement under this plan.

  • Healthcare services means all inpatient services (i.e., acute-care diagnostic and therapeutic inpatient hospital services), outpatient services (i.e., acute-care diagnostic and therapeutic outpatient services, including but not limited to ambulatory surgery and radiology services), and professional services (i.e., medical services provided by physicians or other licensed medical professionals) to the extent offered by Defendant and within the scope of services covered on an in-network basis pursuant to a contract between Defendant and an Insurer. “Healthcare Services” does not mean management of patient care, such as through population health programs or employee or group wellness programs.

  • Basic health care services means in and out-of-area emergency services, inpatient hospital and

  • Child care provider means a provider who receives compensation for providing child care services on a regular basis, including an ‘eligible child care provider’ (as defined in section 658P of the Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858n)).

  • Family child care home means a private home in which 1 but fewer than 7 minor children are received for care and supervision for compensation for periods of less than 24 hours a day, unattended by a parent or legal guardian, except children related to an adult member of the household by blood, marriage, or adoption. Family child care home includes a home in which care is given to an unrelated minor child for more than 4 weeks during a calendar year. A family child care home does not include an individual providing babysitting services for another individual. As used in this subparagraph, "providing babysitting services" means caring for a child on behalf of the child's parent or guardian if the annual compensation for providing those services does not equal or exceed $600.00 or an amount that would according to the internal revenue code of 1986 obligate the child's parent or guardian to provide a form 1099-MISC to the individual for compensation paid during the calendar year for those services.

  • Child support services means any civil, criminal or administrative action taken by the Division of