Common use of Dental Plan Definitions Clause in Contracts

Dental Plan Definitions. The following are words that have special or technical meanings under the pediatric dental services and Benefits described in this Part, and made available under this Contract. a. Accepted Fee means the amount the attending Dental Provider agrees to accept as payment in full for services rendered. b. Benefits mean the amounts that will be paid for covered pediatric dental services. c. Claim Form means the standard form used to file a dental claim, request a dental Pre-Treatment Estimate, or request Prior Authorization. d. Contract Benefit Level is the percentage of the Maximum Contract Allowance paid under the dental plan. e. Dental Deductible means the dollar amount that an Enrollee must satisfy for certain covered dental services before dental Benefits are paid. f. Dental Out-of-Pocket Maximum means the maximum amount that a Member will pay during a Calendar Year for Pediatric dental Benefits from a PPO Provider before Delta Dental begins to pay 100% of the PPO Contracted Fee. Coinsurance and other cost-sharing, including balance billed amounts, will continue to apply for covered Dental Services from Dental Premier Providers and Non-Participating Providers even after the Out-of-Pocket Maximum has been met. g. Dental Provider means a person licensed to practice dentistry when and where services are performed and may be referred to as a “PPO Provider”, a “Premier Provider” or a “Non-Delta Dental Provider”. A Dental Provider will also include a dental partnership, dental professional corporation or dental clinic. h. Eligible Pediatric Individual means a Covered Dependent child under age 20 who is eligible for the pediatric dental Benefits described herein. i. Enrollee means a Covered Dependent child who is an Eligible Pediatric Individual (“Pediatric Enrollee”) enrolled to receive Benefits under the dental plan.

Dental Plan Definitions. The following are words that have special or technical meanings under the pediatric dental services and Benefits described in this Part, and made available under this Contract. a. Accepted Fee means the amount the attending Dental Provider agrees to accept as payment in full for services rendered. b. Benefits mean the amounts that will be paid for covered pediatric dental services. c. Claim Form means the standard form used to file a dental claim, request a dental Pre-Treatment Estimate, or request Prior Authorization. d. Contract Benefit Level is the percentage of the Maximum Contract Allowance paid under the dental plan. e. Dental Deductible means the dollar amount that an Enrollee must satisfy for certain covered dental services before dental Benefits are paid. f. Dental Out-of-Pocket Maximum means the maximum amount that a Member will pay during a Calendar Year calendar year for Pediatric pediatric dental Benefits benefits from a PPO Provider before Delta Dental begins to pay 100% of the PPO Contracted Fee. Coinsurance and other cost-sharing, including balance billed amounts, will continue to apply for covered Dental Services from Dental Premier Providers and Non-Participating Providers even after the Out-of-Pocket Maximum has been met. g. Dental Provider means a person licensed to practice dentistry when and where services are performed and may be referred to as a “PPO Provider”, a “Premier Provider” or a “Non-Delta Dental Provider”. A Dental Provider will also include a dental partnership, dental professional corporation or dental clinic. h. Eligible Pediatric Individual means a Covered Dependent child under age 20 who is eligible for the pediatric dental Benefits described herein. i. Enrollee means a Covered Dependent child who is an Eligible Pediatric Individual (“Pediatric Enrollee”) enrolled to receive Benefits under the dental plan.

Dental Plan Definitions. The following are words that have special or technical meanings under the pediatric dental services and Benefits described in this PartPart XVIII, and made available under this Contract. a. Accepted Fee means the amount the attending Dental Provider agrees to accept as payment in full for services rendered. b. Benefits mean the amounts that will be paid for covered pediatric dental services. c. Claim Form means the standard form used to file a dental claim, request a dental Pre-Treatment Estimate, or request Prior Authorization. d. Contract Benefit Level is the percentage of the Maximum Contract Allowance paid under the dental plan. e. Dental Deductible means the dollar amount that an Enrollee must satisfy for certain covered dental services before dental Benefits are paid. f. Dental Out-of-Pocket Maximum means the maximum amount that a Member will pay during a Calendar Year for Pediatric dental Benefits from a PPO Provider before Delta Dental begins to pay 100% of the PPO Contracted Fee. Coinsurance and other cost-sharing, including balance billed amounts, will continue to apply for covered Dental Services from Dental Premier Providers and Non-Non- Participating Providers even after the Out-of-Pocket Maximum has been met. g. Dental Provider means a person licensed to practice dentistry when and where services are performed and may be referred to as a “PPO Provider”, a “Premier Provider” or a “Non-Delta Dental Provider”. A Dental Provider will shall also include a dental partnership, dental professional corporation or dental clinic. h. Eligible Pediatric Individual means a Covered Dependent child under age 20 who is eligible for the pediatric dental Benefits described herein. i. Enrollee means a Covered Dependent child who is an Eligible Pediatric Individual (“Pediatric Enrollee”) enrolled to receive Benefits under the dental plan. j. Enrollee Pays a Member’s financial obligation for services, calculated as the difference between the amount shown as the ‘Accepted Fee’ and the portion shown as ‘Delta Dental Pays’ on the claims statement when a claim is processed.

Dental Plan Definitions. The following are words that have special or technical meanings under the pediatric dental services and Benefits described in this Part, and made available under this Contract. a. Accepted Fee means the amount the attending Dental Provider agrees to accept as payment in full for services rendered. b. Benefits mean the amounts that will be paid for covered pediatric dental services. c. Claim Form means the standard form used to file a dental claim, request a dental Pre-Treatment Estimate, or request Prior Authorization. d. Contract Benefit Level is the percentage of the Maximum Contract Allowance paid under the dental plan. e. Dental Deductible means the dollar amount that an Enrollee must satisfy for certain covered dental services before dental Benefits are paid. f. Dental Out-of-Pocket Maximum means the maximum amount that a Member will pay during a Calendar Year calendar year for Pediatric pediatric dental Benefits from a PPO Provider before Delta Dental begins to pay 100% of the PPO Contracted Fee. Coinsurance and other cost-sharing, including balance billed amounts, will continue to apply for covered Dental Services from Dental Premier Providers and Non-Participating Delta Dental Providers even after the Out-of-Pocket Maximum has been met. g. Dental Provider means a person licensed to practice dentistry when and where services are performed and may be referred to as a “PPO Provider”, a “Premier Provider” or a “Non-Delta Dental Provider”. A Dental Provider will also include a dental partnership, dental professional corporation or dental clinic. h. Eligible Pediatric Individual means a Covered Dependent child under age 20 who is eligible for the pediatric dental Benefits described herein. i. Enrollee means a Covered Dependent child who is an Eligible Pediatric Individual (“Pediatric Enrollee”) enrolled to receive Benefits under the dental plan.

Dental Plan Definitions. The following are words that have special or technical meanings under the pediatric dental services and Benefits described in this PartPart XVIII, and made available under this Contract. a. Accepted Fee means the amount the attending Dental Provider agrees to accept as payment in full for services rendered. b. Benefits mean the amounts that will be paid for covered pediatric dental services. c. Claim Form means the standard form used to file a dental claim, request a dental Pre-Treatment Estimate, or request Prior Authorization. d. Contract Benefit Level is the percentage of the Maximum Contract Allowance paid under the dental plan. e. Dental Deductible means the dollar amount that an Enrollee must satisfy for certain covered dental services before dental Benefits are paid. f. Dental Out-of-Pocket Maximum means the maximum amount that a Member will pay during a Calendar Year for Pediatric dental Benefits from a PPO Provider before Delta Dental begins to pay 100% of the PPO Contracted Fee. Coinsurance and other cost-sharing, including balance billed amounts, will continue to apply for covered Dental Services from a Dental Premier Providers and Non-Non- Participating Providers even after the Out-of-Pocket Maximum has been met. g. Dental Provider means a person licensed to practice dentistry when and where services are performed and may be referred to as a “PPO Provider”, a “Premier Provider” or a “Non-Delta Dental Provider”. A Dental Provider will shall also include a dental partnership, dental professional corporation or dental clinic. h. Eligible Pediatric Individual means a Covered Dependent child under age 20 who is eligible for the pediatric dental Benefits described herein. i. Enrollee means a Covered Dependent child who is an Eligible Pediatric Individual (“Pediatric Enrollee”) enrolled to receive Benefits under the dental plan. j. Enrollee Pays means a Member’s financial obligation for services, calculated as the difference between the amount shown as the ‘Accepted Fee’ and the portion shown as ‘Delta Dental Pays’ on the claims statement when a claim is processed.

Dental Plan Definitions. The following are words that have special or technical meanings under the pediatric dental services and Benefits described in this PartPart XVIII, and made available under this Contract. a. Accepted Fee means the amount the attending Dental Provider agrees to accept as payment in full for services rendered. b. Benefits mean the amounts that will be paid for covered pediatric dental services. c. Claim Form means the standard form used to file a dental claim, request a dental Pre-Treatment Estimate, or request Prior Authorization. d. Contract Benefit Level is the percentage of the Maximum Contract Allowance paid under the dental plan. e. Dental Deductible means the dollar amount that an Enrollee must satisfy for certain covered dental services before dental Benefits are paid. f. Dental Out-of-Pocket Maximum means the maximum amount that a Member will pay during a Calendar Year for Pediatric dental Benefits from a PPO Provider before Delta Dental begins to pay 100% of the PPO Contracted Fee. Coinsurance and other cost-sharing, including balance billed amounts, will continue to apply for covered Dental Services from a Dental Premier Providers and Non-Non- Participating Providers even after the Out-of-Pocket Maximum has been met. g. Dental Provider means a person licensed to practice dentistry when and where services are performed and may be referred to as a “PPO Provider”, a “Premier Provider” or a “Non-Delta Dental Provider”. A Dental Provider will shall also include a dental partnership, dental professional corporation or dental clinic. h. Eligible Pediatric Individual means a Covered Dependent child under age 20 who is eligible for the pediatric dental Benefits described herein. i. Enrollee means a Covered Dependent child who is an Eligible Pediatric Individual (“Pediatric Enrollee”) enrolled to receive Benefits under the dental plan.