DELTA DENTAL OF WASHINGTON Sample Clauses

DELTA DENTAL OF WASHINGTON. PLAN A ORTHO 1 ORTHO 2 PLAN B ORTHO 1 ORTHO 2 PLAN C ORTHO 1 ORTHO 2 PLAN D ORTHO 1 ORTHO 2 PLAN E ORTHO 1 ORTHO 2 PLAN F ORTHO 1 ORTHO 2 PLAN G ORTHO 1 ORTHO 2 EXPERIENCE GROUP Please complete below rates Experience Plan Choice 1 Experience Plan Choice 2 Employee Only $ Employee Only $ Employee & Spouse $ Employee & Spouse $ Employee & Spouse & 1 Child $ Employee & Spouse & 1 Child $ Employee & Spouse & 2 Child $ Employee & Spouse & 2 Child $ Employee & 1 Child $ Employee & 1 Child $ Employee & 2+ Children $ Employee & 2+ Children $
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DELTA DENTAL OF WASHINGTON. PLAN A PLAN B PLAN C PLAN D ENROLLMENT Experience Plan Choice 1 Experience Plan Choice 2
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DELTA DENTAL OF WASHINGTON. PLAN A PLAN B PLAN C PLAN D PLAN E PLAN F PLAN G EXPERIENCE GROUPPlease complete below rates Experience Plan Choice 1 Experience Plan Choice 2 Employee Only $ Employee Only $ Employee & Spouse/Domestic Partner $ Employee & Spouse/Domestic Partner $ Employee & Spouse/Domestic Partner & 1 Child $ Employee & Spouse/Domestic Partner & 1 Child $ Employee & Spouse/Domestic Partner & 2 Child $ Employee & Spouse/Domestic Partner & 2 Child $ Employee & 1 Child $ Employee & 1 Child $ Employee & 2+ Children $ Employee & 2+ Children $ Willamette Dental Plan Willamette Value Plan ENROLLMENT (Cont.) VISION PLANS Directions: Enter X to select the plans your group wishes to offer to your employees.
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DELTA DENTAL OF WASHINGTON. PLAN A ORTHO 1 ORTHO 2 PLAN B ORTHO 1 ORTHO 2 PLAN C ORTHO 1 ORTHO 2 PLAN D ORTHO 1 ORTHO 2 PLAN E ORTHO 1 ORTHO 2 PLAN F ORTHO 1 ORTHO 2 PLAN G ORTHO 1 ORTHO 2 EXPERIENCE GROUP Please complete below rates Employee Only $ Employee Only $ Employee & Spouse/Domestic Partner $ Employee & Spouse/Domestic Partner $ Employee & Spouse/Domestic Partner & 1 Child $ Employee & Spouse/Domestic Partner & 1 Child $ Employee & Spouse/Domestic Partner & 2 Child $ Employee & Spouse/Domestic Partner & 2 Child $ Employee & 1 Child $ Employee & 1 Child $ Employee & 2+ Children $ Employee & 2+ Children $ II. WILLAMETTE DENTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Willamette – Dental Plan Willamette – Value Plan ENROLLMENT (Cont.) VISION PLANS Directions: Enter X to select the plans your group wishes to offer to your employees.
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Related to DELTA DENTAL OF WASHINGTON

  • Minnesota CANCELLATION section is amended as follows: A ten percent (10%) penalty per month shall be applied to refunds not paid or credited within thirty (30) days of receipt of returned Service Agreement. Mississippi: ARBITRATION section of this Agreement is removed.

  • Oregon Upon failure of the Obligor to perform under the Agreement, the insurer shall pay on behalf of the Obligor any sums the Obligor is legally obligated to pay and any service that the Obligor is legally obligated to perform. Termination of the reimbursement policy shall not occur until a notice of termination has been mailed or delivered to the Director of the Department of Consumer and Business Services. This notice must be mailed or delivered at least 30 days prior to the date of termination. CANCELLATION section is amended as follows: You, the Service Agreement Holder may apply for reimbursement directly to the insurer if a refund or credit is not paid before the 46th day after the date on which Your Agreement is returned to the provider. ARBITRATION section of this Agreement is removed.

  • South Carolina If You purchased this Agreement in South Carolina, complaints or questions about this Agreement may be directed to the South Carolina Department of Insurance, P.O. Box 100105, Columbia, South Carolina 00000-0000, telephone number 000-000-0000. CANCELLATION section is amended as follows: A ten percent (10%) penalty per month shall be applied to refunds not paid or credited within thirty (30) days of receipt of returned Service Agreement.

  • Washington A ten percent (10%) penalty per month shall be applied to refunds not paid or credited within thirty (30) days of receipt of returned service agreement. We may not cancel this Agreement without providing You with written notice at least twenty-one (21) days prior to the effective date of cancellation. Such notice shall include the effective date of cancellation and the reason for cancellation. You are not required to wait sixty (60) days before filing a claim directly with the insurer. ARBITRATION section is amended to add the following: The Insurance Commissioner of Washington is the Service Provider’s attorney to receive service of process in any action, suit or proceeding in any court, and the state of Washington has jurisdiction of any civil action in connection with this Agreement. Arbitration proceedings shall be held at a location in closest proximity to the service Agreement holder’s permanent residence. You may file a direct claim with the insurance company at any time. Wisconsin: ARBITRATION section of this Agreement is removed. CANCELLATION section is amended as follows: Claims paid or the cost of repairs performed shall not be deducted from the amount to be refunded upon cancellation of this Agreement. In the “WHAT IS NOT COVERED” section of this Agreement, exclusion (L) and the “unauthorized repairs and/or parts” exclusion is removed. THIS CONTRACT IS SUBJECT TO LIMITED REGULATION BY THE OFFICE OF THE COMMISSIONER. Proof of loss should be furnished by You to the Administrator as soon as reasonably possible and within one (1) year after the time required by this Agreement. Failure to furnish such notice or proof within the time required by this Agreement does not invalidate or reduce a claim. A ten percent (10%) penalty per month shall be applied to refunds not paid or credited within forty-five (45) days of receipt of returned Service Agreement. If Administrator fails to provide, or reimburse or pay for, a service that is covered under this Agreement within sixty-one (61) days after You provide proof of loss, or if the Administrator becomes insolvent or otherwise financially impaired, You may file a claim directly with the Insurer for reimbursement, payment, or provision of the service.

  • Notice for residents of Washington State Claims Resolution

  • Massachusetts Law This Agreement and all rights and obligations hereunder, including matters of construction, validity, and performance, shall be governed by the laws of The Commonwealth of Massachusetts.

  • Missouri CANCELLATION section is amended as follows: A ten percent (10%) penalty per month shall be applied to refunds not paid or credited within forty-five (45) days of receipt of returned Service Agreement.

  • Arizona In the “WHAT IS NOT COVERED” section of this Agreement, exclusion (E) is removed. CANCELLATION section is amended as follows: No claim incurred or paid will be deducted from the amount to be returned in the event of cancellation. Arbitration does not preclude the consumer’s right to file a complaint with the Arizona Department of Insurance Consumer Affairs Division, (000) 000-0000. Exclusions listed in the Agreement apply once the Covered Product is owned by You.

  • Massachusetts Business Trust With respect to any Fund which is a party to this Agreement and which is organized as a Massachusetts business trust, the term “Fund” means and refers to the trustees from time to time serving under the applicable trust agreement of such trust, as the same may be amended from time to time (the ‘Declaration of Trust”). It is expressly agreed that the obligations of any such Fund hereunder shall not be binding upon any of the trustees, shareholders, nominees, officers, agents or employees of the Fund personally, but bind only the trust property of the Fund as set forth in the applicable Declaration of Trust. In the case of each Fund which is a Massachusetts business trust (in each case, a “Trust”), the execution and delivery of this Agreement on behalf of the Trust has been authorized by the trustees, and signed by an authorized officer, of the Trust, in each case acting in such capacity and not individually, and neither such authorization by the trustees nor such execution and delivery by such officer shall be deemed to have been made by any of them individually, but shall bind only the trust property of the Trust as provided in its Declaration of Trust.

  • Virginia If any promise made in the contract has been denied or has not been honored within 60 days after Your request, You may contact the Virginia Department of Agriculture and Consumer Services, Office of Charitable and Regulatory Programs at xxx.xxxxx.xxxxxxxx.xxx/xxxx-xxxxxxxx-xxxxxxx-xxxxxxxx-xxxxxxxxx.xxxxx to file a complaint.

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