Page 38 - Allegacy 2017 booklet 8.5x11

Allegacy Benefit Solutions Page 38

Glossary of Terms

Late enrollee-an employee or dependent who fails to enroll in the plan within 30
days of becoming eligible

Non-Network-when a member receives services through a non-contracted
provider or facility, benefits are paid by the carrier at a lesser amount. Members
may be required to pay the provider/facility in full and be reimbursed by the
carrier.

Own Occupation-to perform each of the main duties of his or her regular
occupation.

Portability-the ability to obtain life/ad&d insurance when this policy ends prior to
the insured turning age 70, due to reasons stated in the certificate, without
providing evidence of good health.

Pre-existing condition waiting period-late enrollees are subject to a waiting
period of up to 12 months for pre-existing conditions (any condition for which
treatment was sought or which has been diagnosed in the past 3 months).

Usual, customary, & reasonable (UCR)-the dentist’s usual charge for the
service furnished, the charge made for the given dental condition isn’t more
than the usual charge made by most other dentists.

Waiting Period-the amount of time that must pass before an employee/
dependent is eligible to be covered for services under the plan.