Common use of HOW YOUR COVERED DENTAL SERVICES ARE PAID Clause in Contracts

HOW YOUR COVERED DENTAL SERVICES ARE PAID. Payments we make to you are personal and you cannot transfer or assign any of your right to receive payments under this agreement to another person or organization. Our allowance is the maximum amount to be paid for a covered dental service. We will not be responsible for more than the allowance even if more than one dentist renders a covered dental service. You must file all claims within one benefit year of the date you receive a covered dental service. Member submitted claims that arrive after this deadline are invalid unless: • it was not reasonably possible for you to file your claim prior to the filing deadline; AND • you file your claim as soon as possible but no later than ninety (90) calendar days after the filing deadline elapses (unless you are legally incapable). Our payments to you or the dentist fulfill our responsibility under this agreement. In accordance with Rhode Island General Law § 27-20-49, benefits may be assigned and with your written consent our payments can be made to a non-network dentist. Your benefits, however, are personal to you and cannot be assigned, in whole or in part, to another person or organization. Network dentist file claims for you and must do so within one year of providing a covered dental service to you. Non-network dentist may or may not file claims for you. If the non-network dentist does not file the claim on your behalf, you will need to file the claim yourself. To file a claim, please send us an itemized bill including the following: • patient's name; • your member identification number; • the name, address, and telephone number of the dentist who performed the service; • date and description of the service; AND • charge for that service. Please mail the claim to: Blue Cross & Blue Shield of Rhode Island Attention: Blue Cross Dental P. O. Box 219 Providence, RI 02901-0219

HOW YOUR COVERED DENTAL SERVICES ARE PAID. Payments we make to you are personal and you cannot transfer or assign any of your right to receive payments under this agreement to another person or organization. Our allowance is the maximum amount to be paid for a covered dental service. We will not be responsible for more than the allowance even if more than one dentist renders a covered dental service. You must file all claims within one benefit calendar year of the date you receive a covered dental service. Member submitted claims that arrive after this deadline are invalid unless: •  it was not reasonably possible for you to file your claim prior to the filing deadline; AND •  you file your claim as soon as possible but no later than ninety (90) calendar days after the filing deadline elapses (unless you are legally incapable). Our payments to you or the dentist fulfill our responsibility under this agreement. In accordance with Rhode Island General Law § 27-20-49, benefits may be assigned and with your written consent our payments can be made to a non-network dentist. Your benefits, however, are personal to you and cannot be assigned, in whole or in part, to another person or organization. Network dentist dentists file claims for you and must do so within one year of providing a covered dental service to you. Non-network dentist dentists may or may not file claims for you. If the non-network dentist does not file the claim on your behalf, you will need to file the claim yourself. To file a claim, please send us an itemized bill xxxx including the following: •  patient's name; •  your member identification number; •  the name, address, and telephone number of the dentist who performed the service; •  date and description of the service; AND •  charge for that service. Please mail the claim to: Blue Cross & Blue Shield of Rhode Island Attention: Blue Cross Dental P. O. Box 219 ProvidenceXxx 000 Xxxxxxxxxx, RI 02901XX 00000-02190000

HOW YOUR COVERED DENTAL SERVICES ARE PAID. Payments we make to you are personal and you cannot transfer or assign any of your right to receive payments under this agreement to another person or organization. Our allowance is the maximum amount to be paid for a covered dental service. We will not be responsible for more than the allowance even if more than one dentist renders a covered dental service. You must file all claims within one benefit calendar year of the date you receive a covered dental service. Member submitted claims that arrive after this deadline are invalid unless: •  it was not reasonably possible for you to file your claim prior to the filing deadline; AND •  you file your claim as soon as possible but no later than ninety (90) calendar days after the filing deadline elapses (unless you are legally incapable). Our payments to you or the dentist fulfill our responsibility under this agreement. In accordance with Rhode Island General Law § 27-20-49, benefits may be assigned and with your written consent our payments can be made to a non-network dentist. Your benefits, however, are personal to you and cannot be assigned, in whole or in part, to another person or organization. Network dentist dentists file claims for you and must do so within one year of providing a covered dental service to you. Non-network dentist dentists may or may not file claims for you. If the non-network dentist does not file the claim on your behalf, you will need to file the claim yourself. To file a claim, please send us an itemized bill xxxx including the following: •  patient's name; •  your member identification number; •  the name, address, and telephone number of the dentist who performed the service; •  date and description of the service; AND •  charge for that service. Please mail the claim dental claims to: Blue Cross & Blue Shield of Rhode Island Attention: Blue Cross Dental P. O. Box 219 ProvidenceClaims Administer X.X. Xxx 00000 Xxxxxxxxxx, RI 02901XX 00000-02190000

HOW YOUR COVERED DENTAL SERVICES ARE PAID. Payments we make to you are personal and you cannot transfer or assign any of your right to receive payments under this agreement to another person or organization. Our allowance is the maximum amount to be paid for a covered dental service. We will not be responsible for more than the allowance even if more than one dentist renders a covered dental service. You must file all claims within one benefit year of the date you receive a covered dental service. Member submitted claims that arrive after this deadline are invalid unless: • it was not reasonably possible for you to file your claim prior to the filing deadline; AND • you file your claim as soon as possible but no later than ninety (90) calendar days after the filing deadline elapses (unless you are legally incapable). Our payments to you or the dentist fulfill our responsibility under this agreement. In accordance with Rhode Island General Law § 27-20-49, benefits may be assigned and with your written consent our payments can be made to a non-network dentist. Your benefits, however, are personal to you and cannot be assigned, in whole or in part, to another person or organization. Network dentist dentists file claims for you and must do so within one year of providing a covered dental service to you. Non-network dentist dentists may or may not file claims for you. If the non-network dentist does not file the claim on your behalf, you will need to file the claim yourself. To file a claim, please send us an itemized bill including the following: • patient's name; • your member identification number; • the name, address, and telephone number of the dentist who performed the service; • date and description of the service; AND • charge for that service. Please mail the claim to: Blue Cross & Blue Shield of Rhode Island Attention: Blue Cross Dental P. O. Box 219 Providence, RI 02901-0219

HOW YOUR COVERED DENTAL SERVICES ARE PAID. Payments we make to you are personal and you cannot transfer or assign any of your right to receive payments under this agreement to another person or organization. Our allowance is the maximum amount to be paid for a covered dental service. We will not be responsible for more than the allowance even if more than one dentist renders a covered dental service. You must file all claims within one benefit year of the date you receive a covered dental service. Member submitted claims that arrive after this deadline are invalid unless: •  it was not reasonably possible for you to file your claim prior to the filing deadline; AND •  you file your claim as soon as possible but no later than ninety (90) calendar days after the filing deadline elapses (unless you are legally incapable). Our payments to you or the dentist fulfill our responsibility under this agreement. In accordance with Rhode Island General Law § 27-20-49, benefits may be assigned and with your written consent our payments can be made to a non-network dentist. Your benefits, however, are personal to you and cannot be assigned, in whole or in part, to another person or organization. Network dentist dentists file claims for you and must do so within one year of providing a covered dental service to you. Non-network dentist dentists may or may not file claims for you. If the non-network dentist does not file the claim on your behalf, you will need to file the claim yourself. To file a claim, please send us an itemized bill xxxx including the following: •  patient's name; •  your member identification number; •  the name, address, and telephone number of the dentist who performed the service; •  date and description of the service; AND •  charge for that service. Please mail the claim dental claims to: Blue Cross & Blue Shield of Rhode Island Attention: Blue Cross Dental P. O. Box 219 ProvidenceClaims Administer X.X. Xxx 00000 Xxxxxxxxxx, RI 02901XX 00000-02190000

HOW YOUR COVERED DENTAL SERVICES ARE PAID. Payments we make to you are personal and you cannot transfer or assign any of your right to receive payments under this agreement to another person or organization. Our allowance is the maximum amount to be paid for a covered dental service. We will not be responsible for more than the allowance even if more than one dentist renders a covered dental service. You must file all claims within one benefit year of the date you receive a covered dental service. Member submitted claims that arrive after this deadline are invalid unless: • it was not reasonably possible for you to file your claim prior to the filing deadline; AND • you file your claim as soon as possible but no later than ninety (90) calendar days after the filing deadline elapses (unless you are legally incapable). Our payments to you or the dentist fulfill our responsibility under this agreement. In accordance with Rhode Island General Law § 27-20-49, benefits may be assigned and with your written consent our payments can be made to a non-network dentist. Your benefits, however, are personal to you and cannot be assigned, in whole or in part, to another person or organization. Network dentist dentists file claims for you and must do so within one year of providing a covered dental service to you. Non-network dentist dentists may or may not file claims for you. If the non-network dentist does not file the claim on your behalf, you will need to file the claim yourself. To file a claim, please send us an itemized bill xxxx including the following: • patient's name; • your member identification number; • the name, address, and telephone number of the dentist who performed the service; • date and description of the service; AND • charge for that service. Please mail the claim to: Blue Cross & Blue Shield of Rhode Island Attention: Blue Cross Dental P. O. Box 219 ProvidenceXxx 000 Xxxxxxxxxx, RI 02901XX 00000-02190000

HOW YOUR COVERED DENTAL SERVICES ARE PAID. Payments we make to you are personal and you cannot transfer or assign any of your right to receive payments under this agreement to another person or organization. Our allowance is the maximum amount to be paid for a covered dental service. We will not be responsible for more than the allowance even if more than one dentist renders a covered dental service. You must file all claims within one benefit year of the date you receive a covered dental service. Member submitted claims that arrive after this deadline are invalid unless: •  it was not reasonably possible for you to file your claim prior to the filing deadline; AND •  you file your claim as soon as possible but no later than ninety (90) calendar days after the filing deadline elapses (unless you are legally incapable). Our payments to you or the dentist fulfill our responsibility under this agreement. In accordance with Rhode Island General Law § 27-20-49, benefits may be assigned and with your written consent our payments can be made to a non-network dentist. Your benefits, however, are personal to you and cannot be assigned, in whole or in part, to another person or organization. Network dentist dentists file claims for you and must do so within one year of providing a covered dental service to you. Non-network dentist dentists may or may not file claims for you. If the non-network dentist does not file the claim on your behalf, you will need to file the claim yourself. To file a claim, please send us an itemized bill including the following: •  patient's name; •  your member identification number; •  the name, address, and telephone number of the dentist who performed the service; •  date and description of the service; AND •  charge for that service. Please mail the claim to: Blue Cross & Blue Shield of Rhode Island Attention: Blue Cross Dental P. O. Box 219 Providence, RI 02901-0219

HOW YOUR COVERED DENTAL SERVICES ARE PAID. Payments we make to you are personal and you cannot transfer or assign any of your right to receive payments under this agreement to another person or organization. Our allowance is the maximum amount to be paid for a covered dental service. We will not be responsible for more than the allowance even if more than one dentist renders a covered dental service. You must file all claims within one benefit year of the date you receive a covered dental service. Member submitted claims that arrive after this deadline are invalid unless: • it was not reasonably possible for you to file your claim prior to the filing deadline; AND • you file your claim as soon as possible but no later than ninety (90) calendar days after the filing deadline elapses (unless you are legally incapable). Our payments to you or the dentist fulfill our responsibility under this agreement. In accordance with Rhode Island General Law § 27-20-49, benefits may be assigned and with your written consent our payments can be made to a non-network dentist. Your benefits, however, are personal to you and cannot be assigned, in whole or in part, to another person or organization. Network dentist file claims for you and must do so within one year of providing a covered dental service to you. Non-network dentist may or may not file claims for you. If the non-network dentist does not file the claim on your behalf, you will need to file the claim yourself. To file a claim, please send us an itemized bill xxxx including the following: • patient's name; • your member identification number; • the name, address, and telephone number of the dentist who performed the service; • date and description of the service; AND • charge for that service. Please mail the claim to: Blue Cross & Blue Shield of Rhode Island Attention: Blue Cross Dental P. O. Box 219 ProvidenceXxx 000 Xxxxxxxxxx, RI 02901XX 00000-02190000