What does the Predetermination of Benefits clause allow?

The Predetermination of Benefits clause is designed to offer policyholders advance knowledge regarding what their insurance plan will cover for specific medical procedures or treatments. When a claim is submitted for predetermination, the insurance company reviews the proposed services and determines the reimbursement levels before the actual treatment is performed. This feature is beneficial because it allows patients to understand their financial responsibilities and the extent of coverage they can expect. Consequently, this helps in planning for healthcare services without unexpected costs.

The other options do not accurately describe the function of the Predetermination of Benefits clause. For instance, immediate coverage for dental work, coverage for cosmetic procedures, or waiving deductibles pertain to specific insurance terms but do not reflect the purpose of predetermination, which focuses on providing clarity on the benefits that will be paid after services are rendered.