Common use of Enrollee Coinsurance Clause in Contracts

Enrollee Coinsurance. i. The dental plan will pay a percentage of the Maximum Contract Allowance for covered services, subject to certain Limitations, and you are responsible for paying the balance. What you pay is called the enrollee coinsurance (“Enrollee Coinsurance”) and is part of your out-of-pocket cost. You may have to satisfy a Deductible before dental Benefits are paid. You pay the Enrollee Coinsurance even after a Deductible has been met. ii. The amount of your Enrollee Coinsurance will depend on the type of service and the Dental Provider furnishing the service (see the Section titled “Selecting Your Dental Provider”, below). Providers are required to collect Enrollee Coinsurance for covered services. If the Provider discounts, waives or rebates any portion of the Enrollee Coinsurance to you, the dental plan will be obligated to provide as Benefits only the applicable percentages of the Provider’s fees or allowances reduced by the amount of the fees or allowances that is discounted, waived or rebated. iii. It is to your advantage to select PPO Providers because they have agreed to accept the Maximum Contract Allowance as payment in full for covered services, which typically results in lower out-of-pocket costs for you. Please refer to “Selecting Your Dental Provider”, for more information.