Laserfiche WebLink
Reasonable and Customary Charge means the least of: <br />• the amount charged by the Selected General Dentist for a Covered Service; <br />• the usual amount charged by the Selected General Dentist for dental services which are the <br />same as, or similar to, the Covered Service; or <br />• the usual amount charged by other Selected General Dentist in the same geographic area for <br />dental services which are the same as, or similar to, the Covered Service. <br />Resin -based Composite means tooth -colored (white) fillings <br />Selected General Dentist means a SafeGuard contracted dentist who agrees in Writing to provide dental <br />services under special terms, conditions and financial reimbursement arrangements with SafeGuard. <br />Selected General Dental Office means a dental office contracted with SafeGuard consisting of dentists who <br />agree in Writing to provide dental services under special terms, conditions and financial reimbursement <br />arrangements with SafeGuard. <br />Service Area means the geographical area in which SafeGuard has a panel of Selected General Dentists <br />and Specialty Care Dentists who have agreed to provide care to SafeGuard customers. To enroll in the <br />SafeGuard plan, You and Your dependents (except dependent children) must, reside, live, or work in the <br />Service Area. <br />Signed means any symbol or method executed or adopted by a person with the present intention to <br />authenticate a record, which is on or transmitted by paper or electronic media, which is acceptable to Us and <br />consistent with applicable law. <br />Specialty Care means services provided by an endodontist, periodontist, pediatric Dentist, oral surgeon, or <br />orthodontist. These services may be covered at a Co -Payment, or at 75% of the Dentists Reasonable and <br />Customary Charge. <br />Specialty Care Dentist means a SafeGuard contracted dentist who agrees in Writing to provide Specialty <br />Care services under special terms, conditions and financial reimbursement arrangements with SafeGuard. <br />We, Us and Our mean SafeGuard Health Plans, Inc. <br />Written or Writing means a record on or transmitted by paper or electronic media which is acceptable to Us <br />and consistentwith applicable law. <br />Year or Yearly means the 12 month period that begins January 1. <br />You and Your mean a person, other than a dependent, who is covered under the group contract for the <br />dental benefits described in this evidence of coverage. <br />GCERT2011-DHMO-EOC 25^-36 22 <br />