Common use of Maximum Contract Allowance Clause in Contracts

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: i. by a PPO Provider, is the lesser of the Provider’s Submitted Fee or the PPO Provider’s Contracted Fee; or ii. by a Premier Provider, is the lesser of the Provider’s Submitted Fee or the PPO Provider’s Contracted Fee for a PPO Provider in the same geographic area; or iii. by a Non-Delta Dental Provider, is the lesser of the Provider’s Submitted Fee or the PPO Provider’s Contracted Fee for a PPO Provider in the same geographic area.

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: i. by a PPO Provider, is the lesser of the Provider’s Submitted Fee or the PPO Provider’s Contracted Fee; or ii. by a Premier Provider, is the lesser of the Provider’s Submitted Fee or the PPO Provider’s Contracted Fee for a PPO Provider in the same geographic area; or iii. by a Non-Delta Dental Provider, is the lesser of the Provider’s Submitted Fee or the Dental PPO Provider’s Contracted Fee for a PPO Provider in the same geographic area.