Pediatric Dental Benefits Sample Clauses

Pediatric Dental Benefits. When Contractor elects to embed and offer Pediatric Dental Essential Health Benefit services either directly, or through a subcontract with a dental plan issuer authorized to provide Specialized Health Care Services, Contractor shall require its dental plan subcontractor to comply with all applicable provisions of this Agreement, including, but not limited to, standard benefit designs for the embedded pediatric dental benefit, as well as any network adequacy standards applicable to dental provider networks and any pediatric dental quality measures as determined by Covered California.
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Pediatric Dental Benefits. 18.1 Provision of Pediatric Dental Services and Benefits. AvMed has arranged for the delivery of pediatric dental services and Benefits for Covered Dependent children from birth through the end of the Calendar Year in which they turn 19, to be administered by Delta Dental Insurance Company (hereinafter referred to as “Delta Dental”).
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Pediatric Dental Benefits. Blue Shield has contracted with a dental plan administrator (DPA). All pediatric dental plans will be administered by the DPA. Pediatric dental benefits are available for members through the end of the month in which the member turns 19. Dental services are delivered to our members through the DPA’s network of participating providers. If you purchased a Family dental plan that includes a supplemental pediatric dental plan on the Health Benefits Exchange, embedded pediatric dental benefits covered under this plan will be paid first, with the supplemental pediatric dental plan covering non-covered services and/or cost sharing as described in your Family dental Evidence of Coverage. Blue Shield’s dental plans are administered by a contracted Dental Plan Administrator (DPA), which is an entity that contracts with Blue Shield of California to administer the delivery of dental services through a network of Participating Dentists. A DPA also contracts with Blue Shield to serve as a claims administrator for the processing of claims for services received from Non-Participating Dentists. If you have any questions regarding the information in this booklet, need assistance, or have any problems, you may contact your dental Member Services Department at: [0- 000-000-0000].
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Pediatric Dental Benefits. When Contractor elects to embed and offer Pediatric Dental Essential Health Benefit services either directly or, through a subcontract with a dental plan issuer authorized to provide Specialized Health Care Services, to Enrollees under applicable laws, rules and regulations pursuant to: (i) a certificate of authority issued by the CDI under § 699 et seq. of the California Insurance Code, and/or (ii) a license issued by the DMHC pursuant to the Xxxx-Xxxxx Health Care Service Plan Act of 1975 § 1340 et seq. of the California Health and Safety Code. Contractor shall require its dental plan subcontractor to comply with all applicable provisions of this Agreement, including, but not limited to, standard benefit designs for the embedded pediatric dental benefit, as well as any network adequacy standards applicable to dental provider networks and any pediatric dental quality measures as determined by the Exchange.
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Pediatric Dental Benefits. Your Cost for Covered Pediatric Dental Care Services from a Participating Dentist: Diagnostic Evaluations None Preventive Dental Services None Diagnostic Radiographs None Miscellaneous Preventive Dental Services None Basic Restorative Dental Services None Non‐Surgical Extractions None Non‐Surgical Periodontal Services None Adjunctive Services None Endodontic Services None Oral Surgery Services None Surgical Periodontal Services None Major Restorative Services None Prosthodontic Services None Miscellaneous Restorative and Prosthodontic Services None Orthodontic Dental Services None Implant Placement Surgery None COVERED SERVICES EXPENSE LIMITATION — Individual Coverage Out‐of‐Pocket Expense Limitation $1,500* per Calendar Year — Family Coverage Out‐of‐Pocket Expense Limitation $4,500* per Calendar Year LIMITING AGE FOR DEPENDENT CHILDREN 26 (Please refer to the ELIGIBILITY section of this Certificate) * This limit is subject to change or increase as permitted by applicable law. IL‐G‐H‐XX.XX‐PL‐007‐2016 Schedule of Pediatric Vision Coverage Vision Care Services Participating Vision Provider (When a fixed­dollar Copayment is due from the member, the remainder is payable by the Plan up to the Covered Charge*) Exam (with dilation as necessary): No Copayment Frames: “Collection” Frame Frames covered under this Certificate are limited to the “Pediatric Frame Collection” of covered Frames. The “Pediatric Frame Collection” includes a selection of Frame sizes (including adult sizes) for children up to age 19. No Copayment Non‐Collection Frames Note: “Collection” frames with retail values up to $225 are available at no cost at most participating independent providers. Retail chain providers typically do not display the “Collection,” but are required to maintain a comparable selection of frames that are covered in full. You receive 20% off balance of retail cost over $150 allowance Frequency: Examination, Lenses, or Contact Lenses Frame Once every 12­month benefit period IL‐G‐H‐XX.XX‐PL‐007‐2016 Standard Plastic, Glass, or Poly Spectacle Lenses: Single Vision Lined Bifocal Lined Trifocal Lenticular Note: All lenses include scratch resistant coating with no additional Copayment. There may be an additional charge at Walmart and Xxx’s Club No Copayment No Copayment No Copayment No Copayment Lens Options (add to lens prices above): Ultraviolet Protective Coating Polycarbonate Lenses Blended Segment Lenses Intermediate vision Lenses Standard Progressives Premium Progressiv...
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Pediatric Dental Benefits. When Contractor elects to embed and offer pediatric Dental Essential Health Benefit services, Contractor agrees to embed and offer pediatric dental Essential Health Benefit services through a subcontract with a dental plan issuer authorized to provide Specialized Health Care Services to Enrollees under applicable laws, rules and regulations pursuant to: (i) a certificate of authority issued by the CDI under § 699 et seq. of the California Insurance Code, and/or (ii) a license issued by the DMHC pursuant to the Xxxx-Xxxxx Health Care Service Plan Act of 1975 (§ 1340 et seq. of the California Health and Safety Code. Contractor shall require its dental plan issuer subcontractor to comply with all applicable provisions of this Agreement, including, but not limited to, standard benefit designs for the embedded pediatric dental benefit, as well as any network adequacy standards applicable to dental provider networks and any pediatric dental quality measures as determined by the Exchange.
Sample 1
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Pediatric Dental Benefits. Blue Shield has contracted with a dental plan administrator (DPA). All pediatric dental plans will be administered by the DPA. Pediatric dental benefits are available for members through the end of the month in which the member turns 19. Dental services are delivered to our members through the DPA’s network of participating providers. All individual and family medical plans include an embedded pediatric dental benefit. For purposes of coordinating benefits the medical plan is the primary dental benefit plan and the family pediatric dental plan is the secondary dental benefit plan. Family pediatric claims should be submitted to: Blue Shield of California P.O. Box 272540 Chico, CA 95927-2540 Blue Shield’s dental plans are administered by a contracted Dental Plan Administrator (DPA), which is an entity that contracts with Blue Shield of California to administer the delivery of dental services through a network of Participating Dentists. A DPA also contracts with Blue Shield to serve as a claims administrator for the processing of claims for services received from Non-Participating Dentists. If you have any questions regarding the information in this booklet, need assistance, or have any problems, you may contact your dental Member Services Department at: [0- 000-000-0000].
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Pediatric Dental Benefits. Note: This plan requires all enrollees to be under 19 years of age to be covered under the Pediatric Dental plan. See Eligibility and Enrollment for eligibility requirements specific to subscriber and dependents. Important things to know: This plan does not cover services received or ordered when this plan isn’t in effect, or when you aren’t covered under this plan (including services and supplies started before your effective date or after the date coverage ends), except for Major services and root canals that: • Were started after your effective date and before the date your coverage ended under this plan, and • Were completed within 30 days after the date your coverage ended under this plan.
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Related to Pediatric Dental Benefits

  • Dental Benefits The County offers dental and orthodontic benefits to full and part-time regular employees and their eligible dependent(s). Benefit provisions, co­ payments and deductibles are outlined in the Evidence of Coverage. The employee contribution is $13 per pay period ($28.26 per month). The County shall contribute to part-time eligible employees on a pro-rated basis, in accordance with Section 10.2.6.

  • Health and Dental Benefits ‌ During the term of this MOU, the City will provide benefits to all half-time employees as defined by Article 4.1 (Part-Time Employment) of this MOU in accordance with the Civilian Modified Flexible Benefits Program (Flex Program) and any modifications thereto as recommended by the Joint Labor-Management Benefits Committee (JLMBC) and approved by the City Council. During the term of this MOU, the City agrees that it will not unilaterally impose a reduction in plan design or benefits for any benefit plan applicable to employees covered by this MOU. Nothing in this MOU, however, shall prevent the parties from jointly reaching agreement on plan design or benefits applicable to employees covered by this MOU. Additionally, nothing in this MOU constitutes a waiver by the Union or the City with respect to making changes to plan design or benefits. If there are any discrepancies between the benefits described in this Article and the Flex Program approved by the JLMBC, the Flex Program benefits will take precedence.

  • Medical Benefits The Company shall reimburse the Employee for the cost of the Employee's group health, vision and dental plan coverage in effect until the end of the Termination Period. The Employee may use this payment, as well as any other payment made under this Section 6, for such continuation coverage or for any other purpose. To the extent the Employee pays the cost of such coverage, and the cost of such coverage is not deductible as a medical expense by the Employee, the Company shall "gross-up" the amount of such reimbursement for all taxes payable by the Employee on the amount of such reimbursement and the amount of such gross-up.

  • Medical and Dental Benefits If Executive’s employment is subject to a Termination, then to the extent that Executive or any of Executive’s dependents may be covered under the terms of any medical or dental plans of the Company (or an Affiliate) for active employees immediately prior to the Termination Date, then, provided Executive is eligible for and elects coverage under the health care continuation rules of COBRA, the Company shall provide Executive and those dependents with coverage equivalent to the coverage in effect immediately prior to the Termination. For a period of twelve (12) months (18 months for a Termination during a Covered Period), Executive shall be required to pay the same amount as Executive would pay if Executive continued in employment with the Company during such period and thereafter Executive shall be responsible for the full cost of such continued coverage; provided, however, that such coverage shall be provided only to the extent that it does not result in any additional tax or other penalty being imposed on the Company (or an Affiliate) or violate any nondiscrimination requirements then applicable with respect to the applicable plans. The coverages under this Section 4(e) may be procured directly by the Company (or an Affiliate, if appropriate) apart from, and outside of the terms of the respective plans, provided that Executive and Executive’s dependents comply with all of the terms of the substitute medical or dental plans, and provided, further, that the cost to the Company and its Affiliates shall not exceed the cost for continued COBRA coverage under the Company’s (or an Affiliate’s) plans, as set forth in the immediately preceding sentence. In the event Executive or any of Executive’s dependents is or becomes eligible for coverage under the terms of any other medical and/or dental plan of a subsequent employer with plan benefits that are comparable to Company (or Affiliate) plan benefits, the Company’s and its Affiliates’ obligations under this Section 4(e) shall cease with respect to the eligible Executive and/or dependent. Executive and Executive’s dependents must notify the Company of any subsequent employment and provide information regarding medical and/or dental coverage available.

  • Dental Benefit (1) A confirmed staff shall be eligible for reimbursement of expenses incurred for restorative and preventive dental treatment up to $150 per calendar year.

  • Retiree Medical Benefits If Executive is or would become fifty-five (55) or older and Executive's age and service equal sixty-five (65) and Executive has at least five (5) years of service with the Company within two (2) years of Change in Control, Executive is eligible for retiree medical benefits (as such are determined immediately prior to Change in Control). Executive is eligible to commence receiving such retiree medical benefits based on the terms and conditions of the applicable plans in effect immediately prior to the Change in Control.

  • Public Benefits This Agreement provides assurances that the Public Benefits identified below will be achieved and developed in accordance with the Applicable Rules and Project Approvals and with the terms of this Agreement and subject to the City’s Reserved Powers. The Project will provide Public Benefits to the City, including without limitation:

  • Group Benefits To determine if a leave under the provisions of the Family and Medical Leave Act will be a paid or unpaid leave, contact the District’s Human Resources Department.

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