Determination of Benefits. Whenever under this Agreement it is necessary to determine whether one benefit is less than, equal to or larger than another, whether or not such benefits are provided under this Agreement, such determination shall be made by the Company's independent consulting actuary, using mortality, interest and any other assumptions normally used at the time by such actuary in determining actuarial equivalents for the purpose of employee benefit plans of the Company.
Determination of Benefits. When the total cost of eligible dental expenses is expected to exceed the Pre- determination Limit as shown in the Schedule of Dental Benefits (Appendix E), the Dentist’s treatment plan should be sent to the Contract Administrator before the first date of treatment. Based on the treatment plan, the Contract Administrator will estimate the amount of the benefit available if treatment is performed and inform the Dentist of the determination. The treatment plan should:
Determination of Benefits. The Plan will determine the amount of Employee Contributions and the amount of Elective Deferrals of an individual treated as reemployed under this Section 3.11(K) for purposes of applying paragraph Code §414(u)(8)(C) on the basis of the individual's average actual Employee Contributions or Elective Deferrals for the lesser of: (a) the 12‑month period of service with the Employer immediately prior to Qualified Military Service; or (b) the actual length of continuous service with the Employer.
Determination of Benefits. A Member’s financial responsibility for the costs of services will be calculated on the basis of when the service or supply is provided, not when payment is made. Benefits will be pro-rated to account for treatment or portions of stays that occur in more than 1 calendar year. It is solely within the discretion of HMO to determine when benefits are covered under this Certificate.
Determination of Benefits. Usually, before starting extensive dental work, your dentist will tell you what he intends to do and the charge. If the cost of a course of treatment planned by the dentist for a covered family member is expected to exceed $200, the proposed course of treatment must be filed with, and approved by, the Insurance Company prior to the commencement of treatment. The necessary forms are available from your Employer. After reviewing the proposed course of treatment, the Insurance Company will notify both you and your dentist of the estimated payment under the Plan. Because of the difficulty of determining the necessity for the types of services involved after treatment has been received, failure to file and obtain approval may result in benefits of a lesser amount than would otherwise have been payable. Occasionally a patient may select a more expensive procedure rather than a suitable alternate procedure. In such cases, reimbursement will be based on the least expensive procedure which, as determined by the Insurance Company, will produce a professionally adequate result.
Determination of Benefits. The Plan will determine the amount of employee contributions and the amount of elective deferrals of an individual treated as reemployed under this Section 15.2 for purposes of applying paragraph Code §414(u)(8)(C) on the basis of the individual’s average actual employee contributions or elective deferrals for the lesser of: (i) the 12-month period of service with the Employer immediately prior to qualified military service; or (ii) if service with the Employer is less than such 12-month period, the actual length of continuous service with the Employer.
Determination of Benefits. If the cost of a course of treatment planned by the Dentist for a covered family member is expected to exceed $300, the proposed course of treatment must be filed with, and approved by, the Insurance Company prior to the commencement of treatment. In cases where the patient selects a more expensive procedure than a suitable alternative procedure, reimbursement will be based on the least expensive procedure which, as determined by the Insurance Company, will produce a professionally adequate result.
Determination of Benefits. The worker shall provide the District with a copy of the weekly determination of benefits statement received from SDI. This amount shall be deducted from the check paid to the worker by the District.
Determination of Benefits. Where an insured person has been subject successively or alternatively to the applicable legislation of two or more Contracting Parties and has satisfied the conditions for a benefit in the jurisdiction of any of those Contracting Parties, such insured person or the survivors of that person, as the case may be, shall be entitled to the benefit in accordance with the applicable legislation of each of the Contracting Parties concerned.
Determination of Benefits. (a)Claim. A person who believes that he is being denied a benefit to which he is entitled under the Plan (hereinafter referred to as a "Claimant") may file a written request for such benefit with the Bank, setting forth his claim. The request must be addressed to any Senior Vice President of the Bank at its then principal place of business. (b)
