To Whom Benefits Are Paid Sample Clauses

To Whom Benefits Are Paid i. It is not required that the service be provided by a specific dentist. Payment for services provided by a PPO or Premier Provider will be made directly to the dentist. Any other payments will be made to you unless you request in writing when filing a proof of claim that the payment be made directly to the Dental Provider providing the services. All Benefits not paid to the Provider will be payable to you or to your estate, or to an alternate recipient as directed by court order, except that if the person is a minor or otherwise not competent to give a valid release, Benefits may be payable to the parent, guardian or other person actually supporting the minor.
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To Whom Benefits Are Paid i. It is not required that the service be provided by a specific dentist. Payment for services provided by a PPO or Premier Provider will be made directly to the dentist. Any other payments will be made to you unless you request in writing when filing a proof of claim that the payment be made directly to the Dental Provider providing the services. All Benefits not paid to the Provider will be payable to you or to your estate, or to an alternate recipient as directed by court order, except that if the person is a minor or otherwise not competent to give a valid release, Benefits may be payable to his or her parent, guardian or other person actually supporting him or her. 18.7 Deductibles, Maximums, Contract Benefit Levels and Enrollee Coinsurances. Deductibles & Maximums Annual Deductible $65 each Calendar Year Pediatric Enrollee Out-of-Pocket Maximum* Pediatric Enrollee $350 each Calendar Year for only one covered Pediatric Enrollee Multiple Pediatric Enrollees $700 each Calendar Year for two or more covered Pediatric Enrollees ∗ Out-of-Pocket Maximum applies only to Essential Health Benefits that are provided by PPO Providers for Pediatric Enrollees. Once the amount paid by Pediatric Enrollee(s) equals the Dental Out-of-Pocket Maximum, no further payment will be required by the Pediatric Enrollee(s) for the remainder of the Calendar Year for covered services received from PPO Providers. Enrollee Coinsurance and other cost sharing, including balance billed amounts, will continue to apply for covered services from Premier or Non-Delta Dental Providers even after the Dental Out-of-Pocket Maximum is met. ∗ If two or more Pediatric Enrollees are covered, the financial obligation for covered services received from PPO Providers is not more than the multiple-Pediatric Enrollees Dental Out-of-Pocket Maximum. However, once a Pediatric Enrollee meets the Dental Out-of-Pocket Maximum for one covered Pediatric Enrollee, that Pediatric Enrollee will have satisfied his/her Dental Out-of-Pocket Maximum. Other covered Pediatric Enrollees must continue to pay Enrollee Coinsurance for covered services received from PPO Providers until the total amount paid reaches the Dental Out-of-Pocket Maximum for multiple Pediatric Enrollees. Contract Benefit Levels & Enrollee Coinsurances Dental Service Category PPO1 Dental Plan2 Enrollee2 Diagnostic and Preventive Services 100% 0% Basic Services 50% 50% Major Services 50% 50% Medically Necessary Orthodontic Services (requires prior a...
Sample 1
To Whom Benefits Are Paid. Payment for services provided by a DPO Provider or a Premier Provider will be made directly to the Provider. Any other payments provided by this Contract will be made to the Primary Enrollee unless the Primary Enrollee requests when filing proof of loss that the payment be made directly to the Provider providing the services. All Benefits not paid to the Provider will be payable to the Primary Enrollee, to his/her estate, or to an alternate recipient as directed by court order except that if the person is a minor or otherwise not competent to give a valid release, Benefits may be payable to his/her parent, guardian or other person actually supporting him/her.
Sample 1
To Whom Benefits Are Paid. Any payment for Accidental Death becoming due hereunder shall be payable to the beneficiary of record, who shall be the legal beneficiary designated in writing and on file with the Company. If no such designation is then effective, such indemnity shall be payable to the estate of the Insured Person. Any other accrued indemnities, may, at the option of the Company, be paid either to the Insured Person, if living, or the estate of the Insured Person. Any payment made by the Company in good faith pursuant to this provision shall fully discharge the Company to the extent of the payment.
Sample 1

Related to To Whom Benefits Are Paid

  • Oregon Public Service Retirement Plan Pension Program Members For purposes of this Section 2, “employee” means an employee who is employed by the State on or after August 29, 2003 and who is not eligible to receive benefits under ORS Chapter 238 for service with the State pursuant to Section 2 of Chapter 733, Oregon Laws 2003.

  • Covered Benefits and Services The Contractor shall provide to its Hoosier Healthwise members, at a minimum, all benefits and services deemed “medically reasonable and necessary” and covered by the IHCP, and included in the Indiana Administrative Code and under the Contract with the State. A covered service is considered medically necessary if it meets the definition as set forth in 405 IAC 5-2-17. The Contractor shall deliver covered services sufficient in amount, duration or scope to reasonably expect that provision of such services would achieve the purpose of the furnished services. Costs for these services are the basis of the Contractor’s capitation rate and are, therefore, the responsibility of the Contractor. Coverage may not be arbitrarily denied or reduced and is subject to certain limitations in accordance with CFR 438.210(a)(4), which specifies when Contractors may place appropriate limits on services:  On the basis of criteria applied under the State plan, such as medical necessity; or  For the purpose of utilization control, provided the services furnished are sufficient in amount, duration or scope to reasonably be expected to achieve the purpose for which the services are furnished.

  • Plan Benefits Each year, prior to the annual enrollment period, EMPLOYEES will receive Enrollment information that will outline the benefits offered next calendar year. Information relative to specific health insurance benefits and limitations will be updated regularly and contained in the SPD. In the event there is a conflict between the provisions of the collective bargaining agreement and the SPD, the District's SPD shall control.

  • Post-Retirement Benefits The present value of the expected cost of post-retirement medical and insurance benefits payable by the Borrower and its Subsidiaries to its employees and former employees, as estimated by the Borrower in accordance with procedures and assumptions deemed reasonable by the Required Lenders is zero.

  • Supplemental Executive Retirement Plan The Executive shall participate in the Company's Unfunded Pension Plan for Selected Executives (the "SERP").

  • Regular Benefits The Executive shall also be entitled to participate in any and all employee benefit plans, medical insurance plans, life insurance plans, disability income plans, retirement plans, bonus incentive plans and other benefit plans from time to time in effect for senior executives of the Employer. Such participation shall be subject to (i) the terms of the applicable plan documents, (ii) generally applicable policies of the Employer and (iii) the discretion of the Board of Directors of the Employer or any administrative or other committee provided for in or contemplated by such plan.

  • Compensation Benefits Etc During the Employment Period, the Manager shall be compensated as follows:

  • Survivor Benefits 1. A surviving dependent of a retiree who was eligible to receive a Retiree Medical Grant, as stated above in A through C, and who qualifies for a monthly allowance shall be eligible for fifty (50) percent of the Grant authorized for the retiree.

  • REGISTERED RETIREMENT SAVINGS PLAN 1. In this Article:

  • Benefits - In General The Executive shall be permitted during the Term to participate in any group life, hospitalization or disability insurance plans, health programs, equity incentive plans, long-term incentive programs, 401(k) and other retirement plans, fringe benefit programs and similar benefits that may be available (currently or in the future) to other senior executives of the Company generally, in each case to the extent that the Executive is eligible under the terms of such plans or programs.

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