GLOSSARY
As used in this Disclosure Form/Contract.
ADMINISTRATOR means Delta Dental Insurance Company (“Delta Dental”)
or other entity designated by ALPHA, operating as an administrator in the
State of Maryland. Certain functions described throughout this booklet may be
performed by the Administrator, as designated by ALPHA. The mailing address
for the Administrator is 12898 Towne Center Drive, Cerritos, California 90703.
The Administrator will answer calls directed to 800-422-4234.
AUTHORIZATION means the process by which an Administrator determines if a procedure or treatment is a referable covered Benefit under the Enrollee’s plan.
APPLICANT means the individual contracting to obtain dental Benefits as the primary Enrollee. YOU or YOUR refers to the Applicant.
APPLICANT means the individual contracting to obtain dental Benefits as the primary Enrollee. YOU or YOUR refers to the Applicant.
BENEFITS means those dental services which are provided under the terms of this Contract and described in this booklet.
CONTRACT means this agreement between ALPHA and the Applicant including the Enrollment and Payment Authorization Form, the attached schedules, and any appendices, endorsements or riders. This Contract constitutes the entire agreement between the parties.
CONTRACT DENTIST means a Dentist who provides services in general dentistry and who has agreed to provide Benefits to Enrollees under this Program.
CONTRACT ORTHODONTIST means a Dentist who specializes in orthodontics, and who has agreed to provide Benefits to Enrollees under this Program.
CONTRACT SPECIALIST means a Dentist who provides Specialist Services and who has agreed to provide Benefits to Enrollees under this Program.
CONTRACT TERM means the one-year period commencing on the Effective Date and each annual renewal period during which the Contract remains in effect.
COPAYMENT means the amounts shown on Schedule A which an Enrollee pays directly to a Dentist for Benefits.
DENTIST means a duly licensed Dentist legally entitled to practice dentistry at the time and in the state or jurisdiction in which services are performed.
EFFECTIVE DATE means the date coverage begins. If we receive the Premium and the Enrollment and Payment Authorization Form on or before the 21st day of the month, coverage will begin on the first day of the following month. If enrollment materials are received after the 21st day of the month, coverage will begin on the 1st day of the second following month
ELIGIBLE DEPENDENT means any dependent of a primary Enrollee who is eligible for Benefits as described in this Disclosure Form/Contract.
EMERGENCY SERVICES means only those dental services immediately required for alleviation of severe pain, swelling or bleeding or immediately required to avoid placing the Enrollee’s health in serious jeopardy.
ENROLLEE means a person enrolled to receive Benefits under this Program as the primary Enrollee or as an Eligible Dependent.
FULL-TIME STUDENT means a student who is regularly attending an accredited school with an academic schedule of at least 12 credits.
OUT-OF-NETWORK means treatment by a Dentist who has not signed an agreement with ALPHA to provide Benefits under the terms of this Contract.
PREMIUM means the amount payable as provided in this Disclosure Form/Contract.
PRIMARY ENROLLEE means the individual who applies for, and is enrolled in, this Program as the Applicant.
SPECIALIST SERVICES means services performed by a Dentist who specializes in the practice of oral surgery, endodontics, periodontics, orthodontics and pediatric dentistry.
WE, US or OUR means ALPHA or its Administrator, as appropriate. |
