Covered Dental Expenses definition

Covered Dental Expenses means the kinds of expenses which can apply to meet the Deductible or for which Dental Benefits can be paid. Covered Dental Expenses include only certain charges for services or supplies which do not exceed the Reimbursement Rate when ordered by a dentist for dental care and treatment. The charges for services or supplies listed in the Schedule of Benefits are the only charges that are Covered Dental Expenses.
Sample 1Sample 2Sample 3
Covered Dental Expenses mean expenses incurred for Covered Dental Procedures listed herein, which are reasonable, necessary and customary and are performed, recommended or approved by a Dentist legally licensed to practice dentistry, excluding any charges in effect on the date the service is performed, which are in excess of the amount recommended in the Dental Association Fee Guide specified in the Schedule of Insurance herein. Where a Covered Dental Procedure does not appear in the prevailing Fee Guide, the amount of Covered Dental Expense for such procedure will be determined by the insurance carrier on a reasonable and customary basis.
Sample 1Sample 2Sample 3
Covered Dental Expenses means expenses incurred for Covered Dental Procedures listed herein, which are reasonable, necessary and customary and are performed, recommended or approved by a dentist legally licensed to practice dentistry, excluding any charges which are in excess of the amount recommended in the 2001 Dental Association Fee Guide for General Practitioners of the province of residence of the person to whom the service is rendered, in effect on the commencement date of treatment. Where a Covered Dental Procedure does not appear in the prevailing Fee Guide, the amount of covered dental expense for such procedure will be determined by the Insurance Company on a reasonable and customary basis. The effective date of a change in the Dental Association Fee Guide will be deemed to be the first day of the calendar month coincident with or next following the date on which the Insurance Company receives a copy of the revised Schedule. Predetermination of Benefits Payable
Sample 1Sample 2

Examples of Covered Dental Expenses in a sentence

  • 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.

  • The maximum benefit payable for all Covered Dental Expenses incurred during any twelve (12) month period commencing October 1, and ending the following September 30, (except for services described in Section III(C)(4) above) shall be $2,800.00 (effective October 1, 2006) for each individual.

  • Covered Dental Expenses are the usual charges of a dentist which an employee, retired employee or surviving spouse is required to pay for services and supplies which are necessary for treatment of a dental condition, but only to the extent that such services and supplies are customarily employed for treatment of that condition, and only if rendered in accordance with accepted standards of dental practice.

  • 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.

  • Dental Expense Benefits will be payable, subject to the conditions herein, if an employee, retired employee, surviving spouse or eligible dependent, while dental expense coverage is in effect with respect to such individual, incurs Covered Dental Expenses.

  • For Covered Dental Expenses in connection with orthodontics including related oral examinations described in Section III(C)(4) above, the maximum benefit payable shall be $3,600.00 during the lifetime of each individual, with a maximum of $3,200.00 applicable to covered dental expenses provided after October 1, 2003 but before October 1, 2006.

  • If an existing prosthetic appliance was installed under this Dental Expense Benefits Program, charges for the replacement of prosthodontic appliances will be Covered Dental Expenses only if at least five (5) years have elapsed since the date of its installation.

  • Charges for the replacement of an existing denture will be considered as Covered Dental Expenses only if the existing denture is unserviceable and cannot be made serviceable.

  • Payments for Covered Dental Expenses performed by a licensed dentist (or a licensed dental hygienist under conditions specified in Section VII (B) (1)) shall be based upon the applicable percentage of the lesser of the dentist's usual charge for the service or of the fee specified for the service in the Provincial Dental Association Schedule of Fees as defined in Section XIII, but only for the services set forth below, and not for any other services listed in such Schedule of Fees.

  • Provided, however, that in the event no Provincial Dental Association Schedule of Fees is in effect for 2008, payments under this Section III for Covered Dental Expenses, as described in the first sentence of this paragraph, shall be made on the basis of the usual, reasonable and customary charges for the service rendered or supply furnished in 2008.


More Definitions of Covered Dental Expenses

Covered Dental Expenses means the reasonable charges incurred for necessary dental services as specified in this Plan Text and which are performed or prescribed by a Dentist or Denturist.
Sample 1
Covered Dental Expenses does not include charges for or in connection with the following: Original installation of the repair and/or replacement of inlays and fixed bridgework. Services or supplies that are primarily for beautification. Orthodontia or correction of malocclusion Any item received before you or your dependent became insured under this coverage. Any item furnished by or through any government or any subdivision or agency thereof or the charge for which is paid or payable or reimbursable by or through any plan or program of any government or subdivision or agency thereof other than a plan or program established for the civilian employees of government or subdivision or agency thereof. Any charge that would not have been made in the absence of insurance or that the employee or dependent is not legally obligated to pay. Any charges excluded under General Exclusions.
Sample 1
Covered Dental Expenses means the Reasonable and Customary charges for any dental services for Preventive Care, Basic Care and Major Restoration Care as shown under the Schedule of Dental Procedures in the benefits booklet. This amount will not exceed the actual charge. The dental service must be done by a Dentist. A dental hygienist, denturist, or Physician will be considered a Dentist when he or she performs any dental service that is within the scope of his or her license. The dental service must be:
Sample 1

Related to Covered Dental Expenses

  • Medical Expenses means those expenses that an Insured Person has necessarily and actually incurred for medical treatment on account of Illness or Accident on the advice of a Medical Practitioner, as long as these are no more than would have been payable if the Insured Person had not been insured and no more than other hospitals or doctors in the same locality would have charged for the same medical treatment.

  • Maintenance Capital Expenditures means, for any period, the portion of the aggregate amount of all Capital Expenditures of the Borrower for such period attributable to maintenance of property, plant or equipment of the Borrower and the Restricted Subsidiaries, as determined in good faith by a Responsible Officer of the Borrower.

  • local expenditures means expenditures in the currency of the Borrower or for goods or services supplied from the territory of the Borrower; and

  • Qualifying Expenditures means those expenditures for energy conservation measures that have a simple payback period of not less than one year and not more than 10 years and expenditures for the above-market costs of new renewable energy resources, provided that the Oregon Department of Energy may establish by rule a limit on the maximum above-market cost for renewable energy that is allowed as a credit.