1999 011 Ordinance - Laserfiche WebLink

Home Browse Search

03/10/98 16:36 FAX PHIL BRETT -~ LAW DIR f~010 b~/b3/lyy9 E7ti;19 4497775618 FORTIS PAGE 04 ~artis 6enef~s Insurance Company • ~;. 24950 Country Club i31vd, Suite 330, NOrth Olmsted, OH 44070 ' ia: (440~777~170 (800j472-0678 FAX: (440)777-5618 ~ s~ FORTIS' DENTAL CONDITIONS OF QUQTE Our dental product is de9igned to maximize your benefits while minimizing your costs. Following is a brief description of th®proposed plan design with the a:aoaate~d pricing assumptions: Ra7E ASSUiNPT10f1lS • Rates assume a 04/01/1999 effective date and are guaranteed for 12 months. Rates assume 9896 employee and 9890 dependent participation. A Policyholder Affidavit is requir8d to veMy metuat participation. • Rates assume a maximum average of 4 Children per employeB. • Rates assume Home-pfFiceAdminisirattan. '~wERAL INFaitlul~molu - Fortis Benefits requites a minirnum participation of 65% of eligible employees and dependents in order for a cortiract to be issued. EmployQas with d®ntal coverage elsewhere wUl be included in the participation count. Dependents with dental coverage elsewhere will be excluded, but refuse( cards will shit be needed for those individu2ls. t~enefits are paid at the 80th percentile vF tJsua! and Customary, onr; of the highest industry stgnderdS_ Fortis Benefts Chaim forms ere not required; we accept dentists im+oiae. The RAJ benefd maximum is $1 A00. - 1411 coveted dental expenses incurred toward tare deduc4ble and majximum amounts amply to the in-network and out-of-network plan_ F_Ilsl?LaYEE AriD DEpErypENT ELIGIBILITY • Ellglbl@ employee8 era saliva, full-time employees of the policyholder, or an associated wmparry, who are working in tits United States, excluding any temporary or seasonal worKers. Full time means working at IeaSt 30 MOUB per week. • Eligible dependents of insured employees include the employee's lawful spouse and unmarried chiidrt~l teas than age 19 or 24 if a full-time student. TRxlua~rt Tra~-tslEnrr • Transfer treatment ~a,rs when the policyholder has M2d dental tmverage immediately preceding the Fortis Benefits coverage eflecdve date. Na vr,~itinp periods 1Ar1t apply if the employee or the employee's dependents were covered under the policyholder's prior plan on the day before n was replaced by this plan_ • Transfer treatment means that Fortis Benefits wfil pay Pro-rated benefits tpr treabment in progress. as long as th® experrss is a Coverod expense under both plans. For this >o occur, such errlpk>'yees must enroll in the Fortis t3enetits venter plan wiUUn 3t days of Decoming eligible. TIMELY APPLICAtdT WArTING PEWOD A 7imP.ly Applicant Waiting Period does not apply. tarF t~Nrlualrwnmao t~ltloo - - late Entrant Wafting Periods of 6 moMha for Clew 11 t3aeic Restorative Serrlces,72 months tot Class It Basic Non•Restarathre Services ,and Z< months for Clsaa 111 li®aeJor sarvloes wAl apply to employees who enroll in the Fortis Benefits dental plan more then 3t d8ys after becarning eligible. 'oup Na~rl': Meytldd Vlllape ,~~,,,,,a,p