{"component": "definition", "props": {"groups": [{"samples": [{"hash": "7vXRb39HES1", "uri": "https://legacylis.virginia.gov/cgi-bin/legp604.exe?151+ful+HB1609ER+pdf", "label": "legacylis.virginia.gov", "score": 18.2060127258, "published": false}, {"hash": "loQcZY90xmC", "uri": "https://legacylis.virginia.gov/cgi-bin/legp604.exe?141+ful+HB1005H1+pdf", "label": "legacylis.virginia.gov", "score": 18.1368846893, "published": false}, {"hash": "ibQJgTSZDcV", "uri": "https://legacylis.virginia.gov/cgi-bin/legp604.exe?981+ful+HB1075ER+pdf", "label": "legacylis.virginia.gov", "score": 18.1044006348, "published": false}], "size": 43, "snippet_links": [{"key": "the-carrier", "type": "clause", "offset": [28, 39]}, {"key": "payment-to-a", "type": "clause", "offset": [42, 54]}], "snippet": "means the amount from which the carrier's payment to a provider for any", "hash": "f427e70e14ee5f5e191b37d11185639c", "id": 1}, {"samples": [{"hash": "ernaFrn6CBm", "uri": "/contracts/ernaFrn6CBm#allowable-charge", "label": "Limited Benefit Contract", "score": 31.6483592987, "published": true}, {"hash": "19xcSd4BoG0", "uri": "/contracts/19xcSd4BoG0#allowable-charge", "label": "Limited Benefit Contract", "score": 30.6794166565, "published": true}, {"hash": "cl91Jo03zLV", "uri": "/contracts/cl91Jo03zLV#allowable-charge", "label": "Individual Dental Contract", "score": 29.7185153961, "published": true}], "size": 11, "snippet_links": [{"key": "lesser-of", "type": "definition", "offset": [4, 13]}, {"key": "billed-charge", "type": "definition", "offset": [18, 31]}, {"key": "claims-administrator", "type": "clause", "offset": [61, 81]}, {"key": "specific-service", "type": "definition", "offset": [136, 152]}, {"key": "terms-of-this-contract", "type": "clause", "offset": [171, 193]}, {"key": "written-request", "type": "definition", "offset": [206, 221]}, {"key": "a-member", "type": "definition", "offset": [227, 235]}, {"key": "authorized-representative", "type": "clause", "offset": [239, 264]}, {"key": "adverse-benefit-determination", "type": "clause", "offset": [278, 307]}, {"key": "by-the-company", "type": "clause", "offset": [313, 327]}, {"key": "comprised-of", "type": "definition", "offset": [361, 373]}, {"key": "healthcare-service", "type": "definition", "offset": [524, 542]}, {"key": "based-on", "type": "definition", "offset": [560, 568]}, {"key": "information-provided", "type": "clause", "offset": [573, 593]}, {"key": "clinical-review-criteria", "type": "definition", "offset": [609, 633]}, {"key": "medical-necessity", "type": "definition", "offset": [650, 667]}, {"key": "healthcare-setting", "type": "definition", "offset": [692, 710]}, {"key": "level-of-care", "type": "definition", "offset": [715, 728]}, {"key": "guarantee-of-payment", "type": "definition", "offset": [774, 794]}, {"key": "the-member", "type": "clause", "offset": [856, 866]}, {"key": "choice-of-provider", "type": "clause", "offset": [869, 887]}, {"key": "a-person", "type": "definition", "offset": [903, 911]}, {"key": "a-participant", "type": "clause", "offset": [926, 939]}, {"key": "health-insurance-benefit-plan", "type": "definition", "offset": [962, 991]}, {"key": "the-plan", "type": "clause", "offset": [1042, 1050]}, {"key": "for-dental-services", "type": "clause", "offset": [1074, 1093]}, {"key": "under-this-contract", "type": "clause", "offset": [1129, 1148]}, {"key": "services-and", "type": "clause", "offset": [1205, 1217]}, {"key": "the-schedules", "type": "definition", "offset": [1218, 1231]}, {"key": "dental-benefits", "type": "clause", "offset": [1235, 1250]}], "snippet": "The lesser of the billed charge or the amount established by Claims Administrator as the greatest amount this Contract will allow for a specific service covered under the terms of this Contract. Appeal \u2013 A written request from a Member or authorized representative to change an Adverse Benefit Determination made by the Company. Amalgam \u2013 A durable metal alloy comprised of silver, copper, tin and mercury, used in dental restorations. Authorization (Authorized) \u2013 A determination by Claims Administrator regarding a dental healthcare service or supply which, based on the information provided, satisfies the clinical review criteria requirement for Medical Necessity, appropriateness of the healthcare setting, or level of care and effectiveness. An Authorization is not a guarantee of payment. Additionally, an Authorization is not a determination about the Member's choice of Provider. Beneficiary \u2013 A person designated by a participant, or by the terms of a health insurance Benefit Plan, who is or may become entitled to a Benefit under the plan. Benefit(s) \u2013 Coverage for dental services, treatments or procedures provided under this Contract. 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Appeal \u2013 A written request from a Member or authorized representative to change an Adverse Benefit Determination made by the Company. Amalgam \u2013 A durable metal alloy comprised of silver, copper, tin and mercury, used in dental restorations. Authorization (Authorized) \u2013 A determination by UCD regarding a dental healthcare service or supply which, based on the information provided, satisfies the clinical review criteria requirement for Dental Necessity, appropriateness of the healthcare setting, or level of care and effectiveness. An Authorization is not a guarantee of payment. Additionally, an Authorization is not a determination about the Member's choice of Provider. Beneficiary \u2013 A person designated by a participant, or by the terms of a health insurance Benefit Plan, who is or may become entitled to a Benefit under the plan. Benefit(s) \u2013 Coverage for dental services, treatments or procedures provided under this Contract. 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Appeal \u2013 A written request from a Member or authorized representative to change an Adverse Benefit Determination made by the Company. Amalgam \u2013 A durable metal alloy comprised of silver, copper, tin and mercury, used in dental restorations. Annual Deductible \u2013 The dollar amount that each Member must pay out of their own pocket for Covered Services within each Benefit Period before any Benefits are paid under this Benefit Plan. The Annual Deductible will be shown in the Schedule of Dental Benefits, which may be waived for certain services. Authorization (Authorized) \u2013 A determination by Claims Administrator regarding a dental health care service or supply which, based on the information provided, satisfies the clinical review criteria requirement for Medical Necessity, appropriateness of the health care setting, or level of care and effectiveness. An Authorization is not a guarantee of payment. Additionally, an Authorization is not a determination about the Member's choice of Provider. Beneficiary \u2013 A person designated by a participant, or by the terms of a health insurance Benefit Plan, who is or may become entitled to a Benefit under the plan. Benefit(s) \u2013 Coverage for dental services, treatments or procedures provided under this Benefit Plan. 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Appeal \u2013 A written request from a Member or authorized representative to change an Adverse Benefit Determination made by \u2587\u2587\u2587\u2587\u2587 Vision. Authorization (Authorized) \u2013 A determination by \u2587\u2587\u2587\u2587\u2587 Vision that, based on the information provided, a Benefit satisfies the clinical review criteria requirement for Medical Necessity, appropriateness of the healthcare setting, or level of care and effectiveness. An Authorization is not a guarantee of payment. Benefit(s) \u2013 Coverage for the benefits as described in Article IV and the Schedule of Vision Benefits. 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See \u201cAppendices - Definitions.\u201d Brand Name Drug: A prescription drug that has been patented and is produced by only one manufacturer. Cost Share: Has the same meaning as defined in your EOC. 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then We apply Our Coinsurance percentage, up to the Lifetime Maximum Payment amount.", "Your Plan does not pay for fitting or adjustments because this is included in the <strong>Allowable Charge</strong> for the Orthotic Device.", "Once the Member has met any applicable Deductible, Claims Administrator&#x27;s percentage will be applied to the <strong>Allowable Charge</strong> for Covered Services to determine the Benefits provided.", "When You receive covered Medical and Surgical Benefits, We will pay Our Coinsurance percentage of the <strong>Allowable Charge</strong> and You must pay Your percentage."], "related": [["allowable-costs", "Allowable Costs", "Allowable Costs"], ["allowable-cost", "Allowable cost", "Allowable cost"], ["allowable-expenses", "Allowable Expenses", "Allowable Expenses"], ["monthly-charge", "Monthly Charge", "Monthly Charge"], ["allowable-expense", "Allowable Expense", "Allowable Expense"]], "related_snippets": [], "updated": "2025-07-24T04:27:51+00:00"}, "json": true, "cursor": ""}}