Common use of Optional treatment Clause in Contracts

Optional treatment. If you select a more expensive service than is customarily provided, Delta Dental may make an allowance for certain services based on the fee for the customarily provided service. You are responsible for the difference in cost. In all cases, Delta Dental will make the final determination regarding optional treatment and any available allowance. Listed below are services for which Delta Dental will provide an allowance for optional treatment. Remember, you are responsible for the difference in cost for any optional treatment. a. Resin, porcelain fused to metal, and porcelain crowns (including implant crowns), bridge retainers, or pontics on posterior teeth – Delta Dental will pay only the amount that it would pay for a full metal crown. b. Overdentures – Delta Dental will pay only the amount that it would pay for a conventional denture. c. Resin, or porcelain/ceramic onlays on posterior teeth – Delta Dental will pay only the amount that it would pay for a metallic onlay. d. Inlays, regardless of the material used – Delta Dental will pay only the amount that it would pay for an amalgam or composite resin restoration. e. All-porcelain/ceramic bridges – Delta Dental will pay only the amount that it would pay for a conventional fixed bridge. f. Implant/abutment supported complete or partial dentures – Delta Dental will pay only the amount that it would pay for a conventional denture. g. Gold foil restorations – Delta Dental will pay only the amount that it would pay for an amalgam or composite restoration. h. Posterior stainless steel crowns with esthetic facings, veneers or coatings – Delta Dental will pay only the amount that it would pay for a conventional stainless steel crown.

Optional treatment. If you select a more expensive service than is customarily provided, Delta Dental may make an allowance for certain services based on the fee for the customarily provided service. You are responsible for the difference in cost. In all cases, Delta Dental will make the final determination regarding optional treatment and any available allowance. Listed below are services for which Delta Dental will provide an allowance for optional treatment. Remember, you are responsible for the difference in cost for any optional treatment. a. Resin, porcelain fused to metal, and porcelain crowns (including implant crowns), bridge retainers, or pontics on posterior teeth – –Delta Dental will pay only the amount that it would pay for a full metal crown. b. Overdentures – –Delta Dental will pay only the amount that it would pay for a conventional denture. c. Resin, or porcelain/ceramic onlays on posterior teeth – –Delta Dental will pay only for the amount that it would pay for a metallic onlay. d. Inlays, regardless of the material used – –Delta Dental will pay only the amount that it would pay for an amalgam or composite resin restoration. e. All-porcelain/ceramic bridges – –Delta Dental will pay only for the amount that it would pay for a conventional fixed bridge. f. Implant/abutment supported complete or partial dentures – –Delta Dental will pay only for the amount that it would pay for a conventional denture. g. Gold foil restorations – –Delta Dental will pay only for the amount that it would pay for an amalgam or composite restoration. h. Posterior stainless steel crowns with esthetic facings, veneers or coatings – –Delta Dental will pay only for the amount that it would pay for a conventional stainless steel crown.

Optional treatment. If you select a more expensive service than is customarily provided, Delta Dental may make an allowance for certain services based on the fee for the customarily provided service. You are responsible for the difference in cost. In all cases, Delta Dental will make the final determination regarding optional treatment and any available allowance. Listed below are services for which Delta Dental will provide an allowance for optional treatment. Remember, you are responsible for the difference in cost for any optional treatment. a. ResinPlastic, resin, porcelain fused to metal, and porcelain crowns (including implant crowns), bridge retainers, or pontics on posterior teeth – Delta Dental will pay only the amount that it would pay for a full metal crown. b. Overdentures – Delta Dental will pay only the amount that it would pay for a conventional denture. c. ResinPlastic, resin, or porcelain/ceramic onlays on posterior teeth – Delta Dental will pay only the amount that it would pay for a metallic onlay. d. Inlays, regardless of the material used – Delta Dental will pay only the amount that it would pay for an amalgam or composite resin restoration. e. All-porcelain/ceramic bridges – Delta Dental will pay only the amount that it would pay for a conventional fixed bridge. f. Implant/abutment supported complete or partial dentures – Delta Dental will pay only the amount that it would pay for a conventional denture. g. Gold foil restorations – Delta Dental will pay only the amount that it would pay for an amalgam or composite restoration. h. Posterior stainless Stainless steel crowns with esthetic facings, veneers or coatings – Delta Dental will pay only the amount that it would pay for a conventional stainless steel crown.