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Jefferson Pilot Life Ins.#1
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RFP No. 01-10-01 Employee Dental, Life, Insurance
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Jefferson Pilot Life Ins.#1
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Last modified
6/18/2012 10:02:26 PM
Creation date
12/28/2010 3:46:06 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Employee Insurance
Bid No. (xx-xx-xx)
01-10-01
Project Type (Bid, RFP, RFQ)
RFP
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DEFINITIONS <br />SCTIVF, WORK or ACTIVELY AT WORK means an employee's full -time performance of all customary duties of his or her <br />cupation at: <br />(1) the Group Policyholder's place of business; or <br />(2) any other business location where the employee is required to travel. <br />Unless disabled on the prior workday or on the day of absence, an employee will be considered Actively at Work on the following <br />days: <br />(1) a Saturday, Sunday or holiday which is not a scheduled workday; <br />(2) a paid vacation day, or other scheduled or unscheduled non - workday; or <br />(3) an excused or emergency leave of absence (except a medical leave) of three days or less; or a leave of absence <br />which qualifies under the Family and Medical Leave Act (FMLA) of 1993. <br />APPROPRIATE TREATMENT (includes APPROPRIATE) means the range of services and supplies by which a dental condition <br />may be treated, which falls within the accepted standards of dentistry. Appropriate Treatment may vary in techniques, materials <br />utilized and technical complexity, as well as cost. <br />BENEFIT WAITING PERIOD means the period of time a Covered Person must be covered for Dental Expense Benefits -- or for a <br />specific Type of Dental Expense Benefits -- under this Policy before that Type of Service becomes eligible for coverage. <br />COMPANY means Jefferson Pilot Financial Insurance Company, a Nebraska corporation, whose Home Office address is 8801 <br />Indian Hills Drive, Omaha, Nebraska 68114 -4066. <br />COVERAGE MONTH means that period of time: <br />(1) beginning at 12:01 A.M. on the same day of each month as this Policy's anniversary; and <br />(2) ending at 12:00 midnight on the day prior to the same day of the following month; <br />at the Group Policyholder's primary place of business. <br />90VERED EMPLOYEE means an eligible Employee for whom the coverage provided by this Policy is in effect. <br />COVERED EXPENSES, for Employees located in a PPO service area, means expenses incurred for Necessary Dental Procedures <br />shown on the List of Covered Dental Procedures contained in this Policy. Covered Expenses will not exceed: <br />(1) for a Participating Dentist, the Dentist's: <br />(a) fee, as allowed by the Dentist's contract with the dental network; or <br />(b) usual charge for a service; <br />whichever is less. <br />(2) for a Non - Participating Dentist, this Policy's Usual, Customary and Reasonable allowances. <br />These expenses must be Incurred for procedures performed by a Dentist or by a dental hygienist, under the direction of a Dentist. The <br />expenses must be Incurred while covered by this Policy for those procedures for which a claim is being submitted. Covered Expenses <br />are subject to the terms and limitations of this Policy. <br />COVERED EXPENSES, for Employees located outside a PPO service area, means expenses which: <br />(1) are incurred for Necessary Dental Procedures shown on the List of Dental Procedures; and <br />(2) do not exceed the Company's Usual, Customary and Reasonable allowances. <br />These expenses must be Incurred for procedures performed by a Dentist or by a dental hygienist, under the direction of a Dentist. The <br />expenses must be Incurred while covered by this Policy for those procedures for which a claim is being submitted. Covered Expenses <br />are subject to the terms and limitations of this Policy. <br />COVERED PERSON means an eligible Employee or an eligible Dependent for whom the coverage provided by this Policy is in <br />effect. <br />• <br />GL11 -4 -DF <br />4 09/01/01 <br />
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