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Glossary Of Terms

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Please Note: This information is a general reference tool. All terms, conditions and amounts may not be applicable to your benefit plan. Please refer to your Plan Document for a complete listing of terms, conditions, coverage and exclusions of your benefit plan.

Terms Beginning with the Letter "D"

Deductible is the amount of money paid once each Calendar Year per Covered Person. The deductible must be paid before any money is paid by the Plan for any covered services. Deductibles do not accrue toward the 100% maximum out-of-pocket payment.

Deductible Amount is the amount of covered charges for which no benefits will be paid. Before benefits can be paid in a Benefit Year a Covered Person must meet the deductible shown in the Schedule of Benefits.

Deductible for a Common Accident applies when two or more Covered Persons in a Family Unit are injured in the same accident. These persons need not meet separate deductibles for treatment of injuries incurred in this accident; instead only one deductible for the Benefit Year in which the accident occurred will be required for them as a unit.

Deductible Three Month Carryover allows covered expenses incurred in, and applied toward the deductible in October, November and December to be applied toward the deductible in the next Calendar Year.

Dentist is a person who is properly trained and licensed to practice dentistry and who is practicing within the scope of such license.

Dependent Care Program means the program of benefits which provides the reimbursement of eligible expenses for the care of the qualifying dependents or participants.

Designated Health Care Provider shall mean a Physician, group of Physicians, Hospitals or service providers who have contracted for the provision of professional health services to Covered Persons. The Physician, group of Physicians, Hospitals or service providers may be organized as a Preferred Provider Organization (including a Hospital), sole proprietorship, partnership or professional service corporation. Alternatively referred to as a Network, Panel, or PPO.

Durable Medical Equipment means equipment which (a) can withstand repeated use, (b) is primarily and customarily used to serve a medical purpose, (c) generally is not useful to a person in the absence of an Illness or Injury and (d) is appropriate for use in the home.