Maximum Contract Allowance is the reimbursement under the Enrollee’s Plan against which the Dental Provider payment and the Member’s financial obligation are calculated. Subject to adjustment for extreme difficulty or unusual circumstances, the Maximum Contract Allowance for services provided:
Maximum Contract Allowance the reimbursement under the Enrollee’s benefit plan against which Delta Dental calculates payment and the Enrollee’s financial obligation. Subject to adjustment for extreme difficulty or unusual circumstances, the Maximum Contract Allowance for services provided: High Plan by a DPO Provider is the lesser of the Provider’s Submitted Fee or the DPO Contracted Fee. by a Premier Provider is the lesser of the Provider’s Submitted Fee or the Delta Dental Premier Contracted Fee. by a Non-Delta Dental Provider is the lesser of the Provider’s Submitted Fee or the Program Allowance. Low Plan by a DPO Provider is the lesser of the Provider’s Submitted Fee or the DPO Contracted Fee. by a Premier Provider is the lesser of the Provider’s Submitted Fee or the DPO Contracted Fee for a DPO Provider in the same geographic area. by a Non-Delta Dental Provider is the lesser of the Provider’s Submitted Fee or the DPO Contracted Fee for a DPO Provider in the same geographic area.
