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<br />SUNNYISLES <br />5395246 <br /> <br />City of Sunny Isles Beach <br /> <br />The Prior Carrier Credit Provision provides covered persons with a 'credit' toward: <br />covered charges applied to the prior plan's DEDUCTIBLE during the same calendar year. <br />the BENEFIT WAITING PERIOD, if included in the policy, for each covered person's continuous <br />months of coverage under the prior plan just before it terminated. (The 'credit' applies only if the prior <br />plan included the Type(s) of coverage which are subject to the new policy's benefit waiting period.) <br /> <br />The provision also extends coverage for replacement of natural teeth lost while covered under the prior plan <br />and allows the plan to deduct previously paid benefits from the annual and lifetime maximums included in the <br />policy. <br /> <br />BENEFIT WAITING PERIOD <br /> <br />The policy may include a benefit waiting period for employees and dependents. The benefit waiting period is a <br />period of time a person must be covered by the plan before some of the more extensive dental procedures are <br />covered. In takeover situations, credit toward benefit waiting periods may be given for the time employees and <br />dependents were covered under the employer's previous plan. <br /> <br />ALTERNATIVE BENEFITS <br /> <br />The policy covers expenses incurred for necessary dental treatment. In the case where two or more methods <br />of treatment are available, the covered expense will be limited to the least costly option. This determination is <br />based on current professional dental standards and the patient's total oral condition. <br /> <br />PREDETERMINATION OF BENEFITS <br /> <br />The policy includes a provision which allows the patient and the dentist to find out, before the work is done, <br />how much of the dentist's charge will be covered by the plan. It is recommended that this predetermination be <br />used whenever a dentist's charges for non-emergency treatment are expected to exceed $300. <br /> <br />LATE ENTRANT LIMITATION <br /> <br />The policy may include a late entrant limitation of benefits. If included in the policy, the limitation says: <br />When an employee or dependent: <br />- is enrolled in the dental plan for more than 31 days after first becoming eligible; or <br />- cancels then re-enrolls for coverage <br />benefits are limited to Type I Services for the first 12 months of coverage. <br /> <br />The Lincoln National Life Insurance Company <br />8 <br /> <br />2/9/2009 <br />