Life- Threatening medical emergency Magnetic resonance imaging Termination date Benefits Preventive and Diagnostic Treatment Third-Party Administrators PET scan Stop loss (Re- insurance) CT scan Self- funded Holter Monitor Un- erupted tooth Co- insurance HRA Prophylaxis Authorization Deductible Endoscopy Major Treatment Calendar Year Experimental and Investigational Sinusitis Class IV Plan Year Open Enrollment Incurred date Balance Billing Physical therapy Biopsy Second Surgical Opinion High Deductible Health Plan HSA Authorized Personal Representative Dental Caries Observation Echocardiogram Fiduciary Durable Medical Equipment Exclusions Preferred Provider Claim immunization TMJ Pathology Medically Necessary Plan Maximums ERISA Bruxism Medicaid Out-of- Network Sealants Crown Out-of- Pocket Co- payment Birthday rule Medicare Occupational therapy Dialysis Effective date Network EOB Life- Threatening medical emergency Magnetic resonance imaging Termination date Benefits Preventive and Diagnostic Treatment Third-Party Administrators PET scan Stop loss (Re- insurance) CT scan Self- funded Holter Monitor Un- erupted tooth Co- insurance HRA Prophylaxis Authorization Deductible Endoscopy Major Treatment Calendar Year Experimental and Investigational Sinusitis Class IV Plan Year Open Enrollment Incurred date Balance Billing Physical therapy Biopsy Second Surgical Opinion High Deductible Health Plan HSA Authorized Personal Representative Dental Caries Observation Echocardiogram Fiduciary Durable Medical Equipment Exclusions Preferred Provider Claim immunization TMJ Pathology Medically Necessary Plan Maximums ERISA Bruxism Medicaid Out-of- Network Sealants Crown Out-of- Pocket Co- payment Birthday rule Medicare Occupational therapy Dialysis Effective date Network EOB
(Print)
Life-Threatening medical emergency
Magnetic resonance imaging
Termination date
Benefits
Preventive and Diagnostic Treatment
Third-Party Administrators
PET scan
Stop loss (Re-insurance)
CT scan
Self-funded
Holter Monitor
Un-erupted tooth
Co-insurance
HRA
Prophylaxis
Authorization
Deductible
Endoscopy
Major Treatment
Calendar Year
Experimental and Investigational
Sinusitis
Class IV
Plan Year
Open Enrollment
Incurred date
Balance Billing
Physical therapy
Biopsy
Second Surgical Opinion
High Deductible Health Plan
HSA
Authorized Personal Representative
Dental Caries
Observation
Echocardiogram
Fiduciary
Durable Medical Equipment
Exclusions
Preferred Provider
Claim
immunization
TMJ
Pathology
Medically Necessary
Plan Maximums
ERISA
Bruxism
Medicaid
Out-of-Network
Sealants
Crown
Out-of-Pocket
Co-payment
Birthday
rule
Medicare
Occupational therapy
Dialysis
Effective date
Network
EOB
