Primary Dental Provider Assignment. Insurer shall offer each Enrollee a choice of Primary Dental Providers (PDPs) who meet the credentialing, access, and appointment standards of this Contract. In addition to offering Enrollees a choice of PDPs, Insurer shall ensure each Enrollee is assigned to a PDP who acts as an appropriate ongoing source of care and is primarily responsible for coordinating the services accessed by the Enrollee. Insurer may auto-assign Enrollees to PDPs, but Enrollees must be permitted to select another PDP. Should Insurer choose to auto-assign Enrollees to PDPs, Insurer may consider provider quality metrics and outcomes and shall consider the following when making such assignments:
a. The Enrollee’s last PDP assignment, if known;
b. Time and distance from the Enrollee’s home address;
c. Sibling assignments; and
d. The Enrollee’s age and any age limitations with the PDP.
