Common use of COMPLAINT, GRIEVANCE AND APPEAL PROCEDURES Clause in Contracts

COMPLAINT, GRIEVANCE AND APPEAL PROCEDURES. 29 UNDERSTANDING THE BASICS OF YOUR COVERAGE‌‌‌ The Schedules of Dental Benefits control in regards to which dental Benefits are covered, the Waiting Period that is applicable to each Benefit, and the cost sharing (deductibles, coinsurance) applicable to each Benefit. The Schedule will describe the Section to which it apples. The Benefits offered under both of these Sections are limited as stated in each Section. UNITED CONCORDIA DENTAL United Concordia Companies, Inc. d/b/a United Concordia Dental (hereinafter “United Concordia Dental” or “Claims Administrator”) is the Blue Cross and Blue Shield of Louisiana’s network and claims administrator for the dental Benefits provided in this Contract, and is in charge of managing the Dental Network, handling and paying claims, and providing customer services to the Members eligible to receive these benefits and their legal representatives. The Dental Network consists of a select group of Providers who have contracted with United Concordia Dental to render services to Members for discounted fees. All other Providers are considered Non-Participating. Non- Participating Providers may bill you more for their services than Participating Providers. In order to receive the full benefits under this Contract, the Member should verify that a Provider is a United Concordia Dental Network Participating Provider before any service is rendered. To locate a Participating Provider and verify their continued participation in the United Concordia Dental Network, or to ask any questions related to Benefits or claims, please visit the website at xxx.xxxxxx.xxx or contact a customer service representative at (000) 000-0000. We”, “Us” and “Our” in this Contract means the Company or United Concordia Dental when it acts on behalf of Blue Cross and Blue Shield of Louisiana in performing its services under the dental coverage provided for in this Section. Capitalized words are defined terms as described below.

COMPLAINT, GRIEVANCE AND APPEAL PROCEDURES. 29 30 UNDERSTANDING THE BASICS OF YOUR COVERAGE‌‌‌ The Schedules of Dental Benefits control in regards to which dental Benefits are covered, the Waiting Period that is applicable to each Benefit, and the cost sharing (deductibles, coinsurance) applicable to each Benefit. The Schedule will describe the Section to which it apples. The Benefits offered under both of these Sections are limited as stated in each Section. UNITED CONCORDIA DENTAL United Concordia Companies, Inc. d/b/a United Concordia Dental (hereinafter “United Concordia Dental” Dental or “Claims Administrator”UCD) is the Blue Cross and Blue Shield of Louisiana’s network and claims administrator for the dental Benefits provided in this Contract, and is in charge of managing the Dental Network, handling and paying claims, and providing customer services to the Members eligible to receive these benefits and their legal representatives. The Dental Network consists of a select group of Providers who have contracted with United Concordia Dental to render services to Members for discounted fees. All other Providers are considered Non-Participating. Non- Participating Providers may bill you more for their services than Participating Providers. In order to receive the full benefits under this Contract, the Member should verify that a Provider is a United Concordia Dental Network Participating Provider before any service is rendered. To locate a Participating Provider and verify their continued participation in the United Concordia Dental dental Network, or to ask any questions related to Benefits or claims, please visit the website at xxx.xxxxxx.xxx or contact a customer service representative at (000) 000-0000. We”, “Us” Us and “Our” Our in this Contract means the Company or United Concordia Dental when it acts on behalf of Blue Cross and Blue Shield of Louisiana in performing its services under the dental coverage provided for in this Section. Capitalized words are defined terms as described below.

COMPLAINT, GRIEVANCE AND APPEAL PROCEDURES. 29 28 UNDERSTANDING THE BASICS OF YOUR COVERAGE‌‌‌ The Schedules of Dental Benefits control in regards to which dental Benefits are covered, the Waiting Period that is applicable to each Benefit, and the cost sharing (deductibles, coinsurance) applicable to each Benefit. The Schedule will describe the Section to which it apples. The Benefits offered under both of these Sections are limited as stated in each Section. UNITED CONCORDIA DENTAL United Concordia Companies, Inc. d/b/a United Concordia Dental (hereinafter “United Concordia Dental” or “Claims Administrator”) is the Blue Cross and Blue Shield of Louisiana’s network and claims administrator for the dental Benefits provided in this Contract, and is in charge of managing the Dental Network, handling and paying claims, and providing customer services to the Members eligible to receive these benefits and their legal representatives. The Dental Network consists of a select group of Providers who have contracted with United Concordia Dental to render services to Members for discounted fees. All other Providers are considered Non-Participating. Non- Participating Providers may bill you more for their services than Participating Providers. In order to receive the full benefits under this Contract, the Member should verify that a Provider is a United Concordia Dental Network Participating Provider before any service is rendered. To locate a Participating Provider and verify their continued participation in the United Concordia Dental Network, or to ask any questions related to Benefits or claims, please visit the website at xxx.xxxxxx.xxx or contact a customer service representative at (000) 000-0000. We”, “Us” and “Our” in this Contract means the Company or United Concordia Dental when it acts on behalf of Blue Cross and Blue Shield of Louisiana in performing its services under the dental coverage provided for in this Section. Capitalized words are defined terms as described below.