Outside our Service Area Clause Samples
The "Outside our Service Area" clause defines the limitations of a company's obligations or services when a customer is located beyond the geographic boundaries the company serves. Typically, this clause clarifies that certain products, support, or maintenance will not be provided if the customer is outside the designated service area, and may specify how such boundaries are determined or what exceptions, if any, apply. Its core function is to set clear expectations and limit liability by ensuring customers understand where services are available and where the company is not responsible for providing support.
Outside our Service Area. If you are temporarily outside our Service Area, we provide a limited benefit for Emergency Dental Care you receive from Non-Participating Providers or Non-Participating Dental Offices, if we determine that the Services could not be delayed until you returned to our Service Area. Elective care and reasonably foreseen conditions. Elective care and care for conditions that could have been reasonably foreseen are not covered under your Emergency Dental Care or Urgent Dental Care benefits. Follow-up and continuing care is covered only at Participating Dental Offices. You pay the amount shown in the “Benefit Summary.” Deductible, Copayments, Coinsurance, and reimbursement. You pay the amount shown in the “Benefit Summary.” There may be an additional fee added to any other applicable Copayments or Coinsurance when you receive Emergency Dental Care or an Urgent Dental Care appointment from a Participating Provider by the next business day after you contact us. If you require Emergency Dental Care from Non-Participating Providers when you are outside the Service Area, you are provided limited coverage for Services, including local anesthesia and premedication. We will not cover more than the amount shown in the “Benefit Summary” for each incident. Urgent Dental Care. We cover Urgent Dental Care received in our Service Area from Participating Providers and Participating Dental Offices only if the Services would have been covered under other headings of this “Benefits” section (subject to the “Exclusions and Limitations” section) if they were not urgent. Examples include treatment for toothaches, chipped teeth, broken/lost fillings causing irritation, swelling around a tooth, or a broken prosthetic that may require something other than a routine appointment. We do not cover Urgent Dental Care (or other Services that are not Emergency Dental Care) received outside of our Service Area or received from Non-Participating Providers and Non-Participating Dental Offices. Other Benefits Dental Services in conjunction with medically necessary general anesthesia or a medical emergency. We cover the dental Services described in the “Benefits” section when provided in a hospital or ambulatory surgical center, if the Services are performed at that location in order to obtain medically necessary general anesthesia for a member or in a hospital’s emergency department in order to provide dental Services in conjunction with a medical emergency. We do not cover general anesthesia ser...