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Accident and Health Product Filing

Return to Health Information for Insurers

Model Language

Subject Model Language

Cover Page

04/22/2014

Individual - Table of Contents

04/22/2014

Group - Table of Contents

04/22/2014

Definitions

04/22/2014

How This Coverage Works (Introduction, Selecting a Primary Care Dentist, Preauthorization, Medically Necessary)

04/22/2014

Access to Care and Transitional Care (Referrals, Specialty Care Provider as a PCD)

04/22/2014

Cost-Sharing Expenses and Allowed Amount

04/22/2014

Individual - Who Is Covered (Eligibility) (pediatric only coverage)

05/29/2014

Individual - Who Is Covered (Eligibility)

05/29/2014

Group - Who Is Covered (Eligibility) (pediatric only coverage)

04/22/2014

Group - Who Is Covered (Eligibility)

04/22/2014

Pediatric Dental

04/22/2014

Exclusions

04/22/2014

Claim Determinations

04/22/2014

Grievance

06/05/2014

Utilization Review

04/22/2014

External Appeal

04/22/2014

Coordination of Benefits (Group Only)

04/22/2014

Termination

04/22/2014

Extension of Benefits

04/22/2014

Continuation (Group Only)

04/22/2014

Temporary Suspension Rights for Members of the Armed Forces (Individual Only)

04/22/2014

General Provisions (Incontestability, Legal Actions, Subrogation, Unilateral Modification)

04/22/2014

Schedule of Benefits

05/30/2014

Domestic Partner Rider (Group Only)

04/22/2014


Updated 06/05/2014