Common use of Orthodontic Treatment Plan Periodic Payments Clause in Contracts

Orthodontic Treatment Plan Periodic Payments. − Provided there is continued eligibility and treatment, payment of any orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to a Delta Dental PPO Participating Dentist, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. The monthly installment amount on which payment shall be based will be determined by dividing the amount of the orthodontic treatment or the maximum allowable amount for Delta Dental PPO Participating Dentists, whichever is less, by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Delta Dental PPO Participating Dentist any amount of the monthly installment that is not discharged by the DDPOK payment. In the event the Dentist providing orthodontic treatment has not signed a Delta Dental PPO Participating Dentist Agreement but has signed a Delta Dental Premier Participating Dentist Agreement, payment of any orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to a Delta Dental Premier Participating Dentist, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. The monthly installment amount on which payment shall be based will be determined by dividing the amount of the orthodontic treatment or the maximum allowable amount for Delta Dental Premier Participating Dentists, whichever is less, by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Delta Dental Premier Participating Dentist any amount of the monthly installment that is not discharged by the DDPOK payment. In the event the Dentist providing orthodontic treatment has not signed a Participating Dentist Agreement, payment of any orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to the Subscriber, or to other participant or beneficiary if required by law, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. The monthly installment amount on which payment shall be based will be determined by dividing the amount of the orthodontic treatment or the prevailing fee, whichever is less, by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Nonparticipating Dentist both the monthly payment received from DDPOK and any amount of the Nonparticipating Dentist’s monthly installment that is not discharged by the DDPOK payment.

Orthodontic Treatment Plan Periodic Payments. − Provided −Provided there is continued eligibility and treatment, payment of any remaining orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to a Delta Dental PPO Participating Dentist, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. The monthly installment amount on which payment Remaining orthodontic benefits shall be based will be determined by dividing subtracting the amount of maximum allowable down payment from the orthodontic Delta Dental PPO Participating Dentist’s estimated total treatment plan fee or from the maximum allowable amount for Delta Dental PPO Participating Dentists, whichever is less, . The monthly amount on which payment shall be based will be determined by dividing the remaining orthodontic benefits amount by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Delta Dental PPO Participating Dentist any amount of the monthly installment that is not discharged by the DDPOK payment. In the event the Dentist providing orthodontic treatment has not signed a Delta Dental PPO Participating Dentist Agreement but has signed a Delta Dental Premier Participating Dentist Agreement, payment of any remaining orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to a Delta Dental Premier Participating Dentist, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. The monthly installment amount on which payment Remaining orthodontic benefits shall be based will be determined by dividing subtracting the amount of maximum allowable down payment from the orthodontic Delta Dental Premier Participating Dentist’s estimated total treatment plan fee or from the maximum allowable amount for Delta Dental Premier Participating Dentists, whichever is less, . The monthly amount on which payment shall be based will be determined by dividing the remaining orthodontic benefits amount by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Delta Dental Premier Participating Dentist any amount of the monthly installment that is not discharged by the DDPOK payment. In the event the Dentist providing orthodontic treatment has not signed a Participating Dentist Agreement, payment of any remaining orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to the Subscriber, or to other participant or beneficiary if required by law, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. Remaining orthodontic benefits shall be determined by subtracting the maximum allowable down payment from the Nonparticipating Dentist’s estimated total treatment plan fee or from the prevailing fee, whichever is less. The monthly installment amount on which payment shall be based will be determined by dividing the remaining orthodontic benefits amount of the orthodontic treatment or the prevailing fee, whichever is less, by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Nonparticipating Dentist both the monthly payment received from DDPOK and any amount of the Nonparticipating Dentist’s monthly installment that is not discharged by the DDPOK payment.

Orthodontic Treatment Plan Periodic Payments. − Provided there is continued eligibility and treatment, payment of any orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to a Delta Dental PPO Participating Dentist, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. The monthly installment amount on which payment shall be based will be determined by dividing the amount of the orthodontic treatment or the maximum allowable amount for Delta Dental PPO Participating Dentists, whichever is less, by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Delta Dental PPO Participating Dentist any amount of the monthly installment that is not discharged by the DDPOK payment. In the event the Dentist providing orthodontic treatment has not signed a Delta Dental PPO Participating Dentist Agreement but has signed a Delta Dental Premier Participating Dentist Agreement, payment of any orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to a Delta Dental Premier Participating Dentist, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. The monthly installment amount on which payment shall be based will be determined by dividing the amount of the orthodontic treatment or the maximum allowable amount for Delta Dental Premier Participating Dentists, whichever is less, by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Delta Dental Premier Participating Dentist any amount of the monthly installment that is not discharged by the DDPOK payment. In the event the Dentist providing orthodontic treatment has not signed a Participating Dentist Agreement, payment of any orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to the Subscriber, or to other participant or beneficiary if required by law, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. The monthly installment amount on which payment shall be based will be determined by dividing the amount of the orthodontic treatment or the prevailing fee, whichever is less, by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Nonparticipating Dentist both the monthly payment received from DDPOK and any amount of the Nonparticipating Dentist’s monthly installment that is not discharged by the DDPOK payment.

Orthodontic Treatment Plan Periodic Payments. − Provided there is continued eligibility and treatment, payment of any remaining orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to a Delta Dental PPO Participating Dentist, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. The monthly installment amount on which payment Remaining orthodontic benefits shall be based will be determined by dividing subtracting the amount of maximum allowable down payment from the orthodontic Delta Dental PPO Participating Dentist’s estimated total treatment plan fee or from the maximum allowable amount for Delta Dental PPO Participating Dentists, whichever is less, . The monthly amount on which payment shall be based will be determined by dividing the remaining orthodontic benefits amount by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Delta Dental PPO Participating Dentist any amount of the monthly installment that is not discharged by the DDPOK payment. In the event the Dentist providing orthodontic treatment has not signed a Delta Dental PPO Participating Dentist Agreement but has signed a Delta Dental Premier Participating Dentist Agreement, payment of any remaining orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to a Delta Dental Premier Participating Dentist, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. The monthly installment amount on which payment Remaining orthodontic benefits shall be based will be determined by dividing subtracting the amount of maximum allowable down payment from the orthodontic Delta Dental Premier Participating Dentist’s estimated total treatment plan fee or from the maximum allowable amount for Delta Dental Premier Participating Dentists, whichever is less, . The monthly amount on which payment shall be based will be determined by dividing the remaining orthodontic benefits amount by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Delta Dental Premier Participating Dentist any amount of the monthly installment that is not discharged by the DDPOK payment. In the event the Dentist providing orthodontic treatment has not signed a Participating Dentist Agreement, payment of any remaining orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to the Subscriber, or to other participant or beneficiary if required by law, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. Remaining orthodontic benefits shall be determined by subtracting the maximum allowable down payment from the Nonparticipating Dentist’s estimated total treatment plan fee or from the prevailing fee, whichever is less. The monthly installment amount on which payment shall be based will be determined by dividing the remaining Form No. 1000.3 11 of 13 CONFIDENTIAL Appendix B Revised January 2022 orthodontic benefits amount of the orthodontic treatment or the prevailing fee, whichever is less, by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Nonparticipating Dentist both the monthly payment received from DDPOK and any amount of the Nonparticipating Dentist’s monthly installment that is not discharged by the DDPOK payment.

Orthodontic Treatment Plan Periodic Payments. − Provided there is continued eligibility and treatment, payment of any remaining orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to a Delta Dental PPO Participating Dentist, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. The monthly installment amount on which payment Remaining orthodontic benefits shall be based will be determined by dividing subtracting the amount of maximum allowable down payment from the orthodontic Delta Dental PPO Participating Dentist’s estimated total treatment plan fee or from the maximum allowable amount for Delta Dental PPO Participating Dentists, whichever is less, . The monthly amount on which payment shall be based will be determined by dividing the remaining orthodontic benefits amount by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Delta Dental PPO Participating Dentist any amount of the monthly installment that is not discharged by the DDPOK payment. In the event the Dentist providing orthodontic treatment has not signed a Delta Dental PPO Participating Dentist Agreement but has signed a Delta Dental Premier Participating Dentist Agreement, payment of any remaining orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to a Delta Dental Premier Participating Dentist, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. The monthly installment amount on which payment Remaining orthodontic benefits shall be based will be determined by dividing subtracting the amount of maximum allowable down payment from the orthodontic Delta Dental Premier Participating Dentist’s estimated total treatment plan fee or from the maximum allowable amount for Delta Dental Premier Participating Dentists, whichever is less, . The monthly amount on which payment shall be based will be determined by dividing the remaining orthodontic benefits amount by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Delta Dental Premier Participating Dentist any amount of the monthly installment that is not discharged by the DDPOK payment. In the event the Dentist providing orthodontic treatment has not signed a Participating Dentist Agreement, payment of any remaining orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to the Subscriber, or to other participant or beneficiary if required by law, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. Remaining orthodontic benefits shall be determined by subtracting the maximum allowable down payment from the Nonparticipating Dentist’s estimated total treatment plan fee or from the prevailing fee, whichever is less. The monthly installment amount on which payment shall be based will be determined by dividing the remaining orthodontic benefits amount of the orthodontic treatment or the prevailing fee, whichever is less, by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Nonparticipating Dentist both the monthly payment received from DDPOK and any amount of the Nonparticipating Dentist’s monthly installment that is not discharged by the DDPOK payment.

Orthodontic Treatment Plan Periodic Payments. − Provided there is continued eligibility and treatment, payment of any orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to a Delta Dental PPO Participating Dentist, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. The monthly installment amount on which payment shall be based will be determined by dividing the amount of the orthodontic treatment or the maximum allowable amount for Delta Dental PPO Participating Dentists, whichever is less, by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Delta Dental PPO Participating Dentist any amount of the monthly installment that is not discharged by the DDPOK payment. In the event the Dentist providing orthodontic treatment has not signed a Delta Dental PPO Participating Dentist Agreement but has signed a Delta Dental Premier Participating Dentist Agreement, payment of any orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to a Delta Dental Premier Participating Dentist, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. The monthly installment amount on which payment shall be based will be determined by dividing the amount of the orthodontic treatment or the maximum allowable amount for Delta Dental Premier Participating Dentists, whichever is less, by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Delta Dental Premier Participating Dentist any amount of the monthly installment that is not discharged by the DDPOK payment. In the event the Dentist providing orthodontic treatment has not signed a Participating Dentist Agreement, payment of any orthodontic benefits that may be eligible for periodic payments shall be made by DDPOK to the Subscriber, or to other participant or beneficiary if required by law, in monthly installments, at the rate of fifty percent (50%), subject to the maximum orthodontic benefit payment and treatment plan. The monthly installment amount on which payment shall be based will be determined by dividing the amount of the orthodontic treatment or the prevailing fee, whichever is Form No. 1000.3 12 of 13 CONFIDENTIAL Appendix B Revised January 2022 less, by the number of months remaining in the treatment plan. The Subscriber shall be responsible for paying the Nonparticipating Dentist both the monthly payment received from DDPOK and any amount of the Nonparticipating Dentist’s monthly installment that is not discharged by the DDPOK payment.