Common use of Out-of-Network Benefits Clause in Contracts

Out-of-Network Benefits. The out-of-network benefits portion of this Contract provides coverage when You receive Covered Services from Non-Participating Providers. Your out-of-pocket expenses will be higher when You receive out-of-network benefits. In addition to Cost-Sharing, You will also be responsible for paying any difference between the Allowed Amount and the Non- Participating Provider’s charge. READ THIS ENTIRE CONTRACT CAREFULLY. IT IS YOUR RESPONSIBILITY TO UNDERSTAND THE TERMS AND CONDITIONS IN THIS CONTRACT. This Contract is governed by the laws of New York State. The insurance evidenced by this Contract provides DENTAL insurance ONLY. This Contract is a New York State of Health, The Official Health Plan Marketplace, certified stand- alone dental plan offered outside the New York State of Health. By: Xxxxxxxxxxx Del Xxxxxxx, Chief Executive Officer MVP Health Services Corp. TABLE OF CONTENTS SECTION I - Definitions 4 SECTION II - How Your Coverage Works 9 C. Participating Providers 9 D. The Role of Primary Care Dentists 9

Out-of-Network Benefits. The out-of-network benefits portion of this Contract provides coverage when You receive Covered Services from Non-Participating Providers. Your out-of-pocket expenses will be higher when You receive out-of-network benefits. In addition to Cost-Sharing, You will also be responsible for paying any difference between the Allowed Amount and the Non- Non-Participating Provider’s charge. READ THIS ENTIRE CONTRACT CAREFULLY. IT IS YOUR RESPONSIBILITY TO UNDERSTAND THE TERMS AND CONDITIONS IN THIS CONTRACT. This Contract is governed by the laws of New York State. The insurance evidenced by this Contract provides DENTAL insurance ONLY. This Contract is a New York State of Health, The Official Health Plan Marketplace, certified stand- stand-alone dental plan offered outside the New York State of Health. By: Xxxxxxxxxxx Del Xxxxxxx, Chief Executive Officer MVP Health Services Corp. TABLE OF CONTENTS SECTION I - Definitions 4 SECTION II - How Your Coverage Works 9 10 C. Participating Providers 9 10 D. The Role of Primary Care Dentists 910

Out-of-Network Benefits. The out-of-network benefits portion of this Contract provides coverage when You receive Covered Services from Non-Participating Providers. Your out-of-pocket expenses will be higher when You receive out-of-network benefits. In addition to Cost-Sharing, You will also be responsible for paying any difference between the Allowed Amount and the Non- Non-Participating Provider’s charge. READ THIS ENTIRE CONTRACT CAREFULLY. IT IS YOUR RESPONSIBILITY TO UNDERSTAND THE TERMS AND CONDITIONS IN THIS CONTRACT. This Contract is governed by the laws of New York State. The insurance evidenced by this Contract provides DENTAL insurance ONLY. This Contract is a New York State of Health, The Official Health Plan Marketplace, certified stand- alone dental plan offered outside the New York State of Health. By: Xxxxxxxxxxx Del Xxxxxxx, Chief Executive Officer MVP Health Services Corp. TABLE OF CONTENTS SECTION I - Definitions 4 SECTION II - How Your Coverage Works 9 C. Participating Providers 9 D. The Role of Primary Care Dentists 9

Out-of-Network Benefits. The out-of-network benefits portion of this Contract provides coverage when You receive Covered Services from Non-Participating Providers. Your out-of-pocket expenses will be higher when You receive out-of-network benefits. In addition to Cost-Sharing, You will also be responsible for paying any difference between the Allowed Amount and the Non- Non-Participating Provider’s charge. READ THIS ENTIRE CONTRACT CAREFULLY. IT IS YOUR RESPONSIBILITY TO UNDERSTAND THE TERMS AND CONDITIONS IN THIS CONTRACT. This Contract is governed by the laws of New York State. The insurance evidenced by this Contract provides DENTAL insurance ONLY. This Contract is a New York State of Health, The Official Health Plan Marketplace, certified stand- stand-alone dental plan offered outside the New York State of Health. By: Xxxxxxxxxxx Del Xxxxxxx, Chief Executive Officer MVP Health Services Corp. TABLE OF CONTENTS SECTION I - – Definitions 4 SECTION II - How Your Coverage Works 9 10 C. Participating Providers 9 10 D. The Role of Primary Care Dentists 910

Out-of-Network Benefits. The out-of-network benefits portion of this Contract provides coverage when You receive Covered Services from Non-Participating Providers. Your out-of-pocket expenses will be higher when You receive out-of-network benefits. In addition to Cost-Sharing, You will also be responsible for paying any difference between the Allowed Amount and the Non- Participating Provider’s charge. READ THIS ENTIRE CONTRACT CAREFULLY. IT IS YOUR RESPONSIBILITY TO UNDERSTAND THE TERMS AND CONDITIONS IN THIS CONTRACT. This Contract is governed by the laws of New York State. The insurance evidenced by this Contract provides DENTAL insurance ONLY. This Contract is a New York State of Health, The Official Health Plan Marketplace, certified stand- alone dental plan offered outside the New York State of Health. By: Xxxxxxxxxxx Del Xxxxxxx, Chief Executive Officer MVP Health Services Corp. TABLE OF CONTENTS SECTION I - – Definitions 4 SECTION II - How Your Coverage Works 9 8 C. Participating Providers 9 8 D. The Role of Primary Care Dentists 98