Common use of Using Your Clause in Contracts

Using Your. Identification Card We provide each Member with a Company Identification (ID) card that contains the Member health record number. Please have your health record number available when you call for advice, make an appointment, or seek Services. We use your health record number to identify your dental records, for billing purposes and for membership information. You should always have the same health record number. If we ever inadvertently issue you more than one health record number, please let us know by calling Member Services. If you need to replace your ID card, please call Member Services. Your ID card is for identification only and it does not entitle you to Services. To receive covered Services, you must be a current Member. Anyone who is not a Member will be billed as a non-member for any Services he or she receives. If you let someone else use your ID card, we may keep your card and terminate your membership (see the “Termination for Cause” section). We may request photo identification in conjunction with your ID card to verify your identity. Getting Assistance We want you to be satisfied with the dental care you receive. If you have any questions or concerns, please discuss them with your personal care Participating Dentist or with other Participating Providers who are treating you. Most Participating Dental Offices have an administrative office staffed with representatives who can provide assistance if you need help obtaining Services. Member Services representatives are also available to assist you Monday through Friday (except holidays), from 8 a.m. to 6 p.m. Portland area ▇▇▇-▇▇▇-▇▇▇▇ All other areas ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY for the hearing and speech impaired ▇-▇▇▇-▇▇▇-▇▇▇▇ Language interpretation services ▇-▇▇▇-▇▇▇-▇▇▇▇ You may also e-mail us by registering on our website at ▇▇.▇▇▇/▇▇▇▇▇▇/▇▇. Member Services representatives can answer any questions you have about your benefits, available Services, and the facilities where you can receive Services. For example, they can explain your dental benefits, how to make your first dental appointment, what to do if you move, what to do if you need Emergency Dental Care while you are traveling, and how to replace your ID card. These representatives can also help you if you need to file a claim, or a complaint, grievance or appeal as described in the “Grievances, Claims, and Appeals” section. Upon request, Member Services can also provide you with written materials about your coverage. Choosing a Personal Care Dentist Your personal care Participating Dentist plays an important role in coordinating your dental care needs, including routine dental visits and referrals to specialists. We encourage you and your Dependents to choose a personal care Participating Dentist. To learn how to choose or change your personal care Participating Dentist, please call Member Services. The online dental directory provides the names, locations, and telephone numbers of Participating Dentists. Before receiving Services, you should confirm your dentist has continued as a Participating Dentist. To do so, you may call Member Services at ▇▇▇-▇▇▇-▇▇▇▇ from within Portland, ▇-▇▇▇-▇▇▇-▇▇▇▇ from outside the Portland area, via TTY at ▇-▇▇▇-▇▇▇-▇▇▇▇, or you may email us by registering at ▇▇.▇▇▇/▇▇▇▇▇▇/▇▇ for the most up-to-date provider information. Participating Dentists include both general dentists and specialists. Appointments for Routine Services If you need to make a routine dental care appointment, please refer to the Dental Directory for appointment telephone numbers, or go to ▇▇.▇▇▇/▇▇▇▇▇▇/▇▇ to request an appointment online. Routine appointments are for dental needs that are not urgent such as checkups, teeth cleanings, and follow-up visits that can wait more than a day or two. Try to make your routine care appointments as far in advance as possible. For information about getting other types of care, refer to “Emergency and Urgent Dental Care” in this “How to Obtain Services” section. Utilization Review When you need Services, you should talk with your Participating Provider about your dental needs or your request for Services. Your Participating Provider provides covered Services that are Dentally Necessary. Participating Providers will use their judgment to determine if Services are Dentally Necessary. If you seek a specific Service, you should talk with your Participating Provider. Your Participating Provider will discuss your needs and recommend an appropriate course of treatment. If you request Services that the Participating Provider believes are not Dentally Necessary, you may ask for a second opinion from another Participating Provider. You should contact the manager in the area where the Participating Provider is located. Member Services can connect you with the correct manager, who will listen to your issues and discuss the request with the Participating Provider.

Using Your. Identification Card We provide each Member with a Company Identification (ID) card that contains the Member health record number. Please have Have your health record number available when you call for advice, make an appointment, or seek Services. We use your health record number to identify your dental records, for billing purposes and for membership information. You should always have the same health record number. If we ever inadvertently issue you more than one health record number, please let us know by calling Member Services. If you need to replace your ID card, please call Member Services. Your ID card is for identification only and it does not entitle you to Services. To receive covered Services, you must be a current Member. Anyone who is not a Member will be billed as a non-member for any Services he or she receives. If you let someone else use your ID card, we may keep your card and terminate your membership (see the “Termination for Cause” section). We may request photo identification in conjunction with your ID card to verify your identity. Getting Assistance We want you to be satisfied with the dental care you receive. If you have any questions or concerns, please discuss them with your personal care Participating Dentist or with other Participating Providers who are treating you. Most Participating Dental Offices have an administrative office staffed with representatives who can provide assistance if you need help obtaining Services. Member Services representatives are also available to assist you Monday through Friday (except holidays), from 8 a.m. to 6 p.m. Portland area ▇▇▇-▇▇▇-▇▇▇▇ All other areas ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY for the hearing and speech impaired ▇-▇▇▇-▇▇▇-▇▇▇▇ Language interpretation services ▇-▇▇▇-▇▇▇-▇▇▇▇ You may also e-mail us by registering on our website at ▇▇.▇▇▇/▇▇▇▇▇▇/▇▇. Member Services representatives can answer any questions you have about your benefits, available Services, and the facilities where you can receive Services. For example, they can explain your dental benefits, how to make your first dental appointment, what to do if you move, what to do if you need Emergency Dental Care while you are traveling, and how to replace your ID card. These representatives can also help you if you need to file a claim, or a complaint, grievance or appeal as described in the “Grievances, Claims, and Appeals” section. Upon request, Member Services can also provide you with written materials about your coverage. Choosing a Personal Care Dentist Your personal care Participating Dentist plays an important role in coordinating your dental care needs, including routine dental visits and referrals to specialists. We encourage you and your Dependents to choose a personal care Participating Dentist. To learn how to choose or change your personal care Participating Dentist, please call Member Services. The online dental directory provides the names, locations, and telephone numbers of Participating Dentists. Before receiving Services, you should confirm your dentist has continued as a Participating Dentist. To do so, you may call Member Services at ▇▇▇-▇▇▇-▇▇▇▇ from within Portland, ▇-▇▇▇-▇▇▇-▇▇▇▇ from outside the Portland area, via TTY at ▇-▇▇▇-▇▇▇-▇▇▇▇, or you may email us by registering at ▇▇.▇▇▇/▇▇▇▇▇▇/▇▇ for the most up-to-date provider information. Participating Dentists include both general dentists and specialists. Appointments for Routine Services If you need to make a routine dental care appointment, please refer to the Dental Directory for appointment telephone numbers, or go to ▇▇.▇▇▇/▇▇▇▇▇▇/▇▇ to request an appointment online. Routine appointments are for dental needs that are not urgent such as checkups, teeth cleanings, and follow-up visits that can wait more than a day or two. Try to make your routine care appointments as far in advance as possible. For information about getting other types of care, refer to “Emergency and Urgent Dental Care” in this “How to Obtain Services” section. Utilization Review When you need Services, you should talk with your Participating Provider about your dental needs or your request for Services. Your Participating Provider provides covered Services that are Dentally Necessary. Participating Providers will use their judgment to determine if Services are Dentally Necessary. If you seek a specific Service, you should talk with your Participating Provider. Your Participating Provider will discuss your needs and recommend an appropriate course of treatment. If you request Services that the Participating Provider believes are not Dentally Necessary, you may ask for a second opinion from another Participating Provider. You should contact the manager in the area where the Participating Provider is located. Member Services can connect you with the correct manager, who will listen to your issues and discuss the request with the Participating Provider.