Benefit Summary definition
Benefit Summary shows the Dependent Limiting Age (the “Student” one is for students, and the “General” one is for non-students). Emergency Dental Care. Dentally Necessary Services to treat Emergency Dental Conditions. Emergency Dental Condition. A dental condition, or exacerbation of an existing dental condition, occurring suddenly and unexpectedly, involving injury, swelling, bleeding, or extreme pain in or around the teeth and gums that would lead a prudent layperson possessing an average knowledge of health and medicine to reasonably expect that immediate dental attention is needed.
Benefit Summary shows the Dependent Limiting Age (the student Dependent Limiting Age is for students, and the general Dependent Limiting Age is for non-students). Emergency Dental Care. Dentally Necessary Services to treat Emergency Dental Conditions. Emergency Dental Condition. A dental condition, or exacerbation of an existing dental condition, occurring suddenly and unexpectedly, involving injury, swelling, bleeding, or extreme pain in or around the teeth and gums that would lead a prudent layperson possessing an average knowledge of health and medicine to reasonably expect that immediate dental attention is needed. Family. A Subscriber and their Spouse and/or Dependents. Group. The employer, union trust, or association with which we have an Agreement that includes this EOC. Hospital Services. Medical services or dental Services provided in a hospital or ambulatory surgical center. ▇▇▇▇▇▇ Permanente. Kaiser Foundation Hospitals (a California nonprofit corporation), Company, and Permanente Dental Associates, PC. Medically Necessary. Our determination that the Service is all of the following: (i) medically required to prevent, diagnose or treat your condition or clinical symptoms; (ii) in accordance with generally accepted standards of medical practice; (iii) not solely for the convenience of you, your family and/or your provider; and, (iv) the most appropriate level of Service which can safely be provided to you. For purposes of this definition, “generally accepted standards of medical practice” means (a) standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community; (b) physician specialty society recommendations; (c) the view of physicians practicing in the relevant clinical area or areas within ▇▇▇▇▇▇ Permanente locally or nationally; and/or (d) any other relevant factors reasonably determined by us. Unless otherwise required by law, we decide if a Service is Medically Necessary. You may appeal our decision as set forth in the “Grievances, Claims, and Appeals” section. The fact that a Participating Provider has prescribed, recommended, or approved a Service does not, in itself, make such Service Medically Necessary and, therefore, a covered Service.
Benefit Summary shows the Dependent Limiting Age (the student Dependent Limiting Age is for students, and the general Dependent Limiting Age is for non-students). Emergency Dental Care. Dentally Necessary Services to treat Emergency Dental Conditions. Emergency Dental Condition. A dental condition, or exacerbation of an existing dental condition, occurring suddenly and unexpectedly, involving injury, swelling, bleeding, or extreme pain in or around the teeth and gums that would lead a prudent layperson possessing an average knowledge of health and medicine to reasonably expect that immediate dental attention is needed. Family. A Subscriber and his or her Spouse and/or Dependents.
Examples of Benefit Summary in a sentence
While this Plan is in force, upon the death of the Insured Person, this benefit shall be payable as stated in the Benefit Summary.
More Definitions of Benefit Summary
Benefit Summary means the summary of benefits contained in Section 1.2 above which sets out, among others, the benefit items and maximum benefits covered under the Plan.
Benefit Summary means the summary of benefits contained in Section 1.2 of the Plan Terms and Conditions which sets out, among others, the benefit items and benefit limits.
Benefit Summary means the benefit document that sets forth specific coverages by Participating Employer. The Benefit Summary is incorporated by reference into the plan.
Benefit Summary shows the Dependent Limiting Age (the “Student” one is for students, and the “General” one is for non-students). Emergency Dental Care. Dentally Necessary Services to treat Emergency Dental Conditions. Emergency Dental Condition. A dental condition, or exacerbation of an existing dental condition, occurring suddenly and unexpectedly, involving injury, swelling, bleeding, or extreme pain in or around the teeth and gums that would lead a prudent layperson possessing an average knowledge of health and medicine to reasonably expect that immediate dental attention is needed. Evidence of Coverage (EOC). This Evidence of Coverage document provided to the Member that specifies and describes benefits and conditions of coverage. This document, on its own, is not designed to meet the requirements of a summary plan description (SPD) under ▇▇▇▇▇. Family. A Subscriber and his or her Spouse and/or Dependents.
Benefit Summary shows the Dependent Limiting Age (the “Student” one is for students, and the “General” one is for non-students). Emergency Dental Care. Dentally Necessary Services to treat Emergency Dental Conditions. Emergency Dental Condition. A dental condition, or exacerbation of an existing dental condition, occurring suddenly and unexpectedly, involving injury, swelling, bleeding, or extreme pain in or around the teeth and gums that would lead a prudent layperson possessing an average knowledge of health and medicine to reasonably expect that immediate dental attention is needed. Family. A Subscriber and his or her Spouse and/or Dependents.