Preventive services and immunizations for dependent children up to age 13. Benefits are not subject to the deductible. Benefits are subject to annual deductibles and policy maximums.
Prior authorization is required.
A Covered Expense is deemed to be incurred on the date such service or supple, that gave rise to the expense or charge, was rendered or obtained. The Company reserves the right of final determination of the amount payable for any service or supply. Usual - an amount a professional provider usually charges for a given service. Customary - an amount which falls within the range of charges for a given service billed by most professional providers in the same locality who have similar training and experience. Reasonable - an amount that, in the opinion of the Company, would not be considered excessive in a particular case.