To Whom Benefits Are Paid i. It is not required that the service be provided by a specific dentist. Payment for services provided by a PPO or Premier Provider will be made directly to the dentist. Any other payments will be made to you unless you request in writing when filing a proof of claim that the payment be made directly to the Dental Provider providing the services. All Benefits not paid to the Provider will be payable to you or to your estate, or to an alternate recipient as directed by court order, except that if the person is a minor or otherwise not competent to give a valid release, Benefits may be payable to the parent, guardian or other person actually supporting the minor.
To Whom Benefits Are Paid i. It is not required that the service be provided by a specific dentist. Payment for services provided by a PPO or Premier Provider will be made directly to the dentist. Any other payments will be made to you unless you request in writing when filing a proof of claim that the payment be made directly to the Dental Provider providing the services. All Benefits not paid to the Provider will be payable to you or to your estate, or to an alternate recipient as directed by court order, except that if the person is a minor or otherwise not competent to give a valid release, Benefits may be payable to his or her parent, guardian or other person actually supporting him or her. 18.7 Deductibles, Maximums, Contract Benefit Levels and Enrollee Coinsurances. Annual Deductible $65 each Calendar Year Pediatric Enrollee Pediatric Enrollee $350 each Calendar Year for only one covered Pediatric Enrollee Multiple Pediatric Enrollees $700 each Calendar Year for two or more covered Pediatric Enrollees ∗ Out-of-Pocket Maximum applies only to Essential Health Benefits that are provided by PPO Providers for Pediatric Enrollees. Once the amount paid by Pediatric Enrollee(s) equals the Dental Out-of-Pocket Maximum, no further payment will be required by the Pediatric Enrollee(s) for the remainder of the Calendar Year for covered services received from PPO Providers. Enrollee Coinsurance and other cost sharing, including balance billed amounts, will continue to apply for covered services from Premier or Non-Delta Dental Providers even after the Dental Out-of-Pocket Maximum is met. ∗ If two or more Pediatric Enrollees are covered, the financial obligation for covered services received from PPO Providers is not more than the multiple-Pediatric Enrollees Dental Out-of-Pocket Maximum. However, once a Pediatric Enrollee meets the Dental Out-of-Pocket Maximum for one covered Pediatric Enrollee, that Pediatric Enrollee will have satisfied his/her Dental Out-of-Pocket Maximum. Other covered Pediatric Enrollees must continue to pay Enrollee Coinsurance for covered services received from PPO Providers until the total amount paid reaches the Dental Out-of-Pocket Maximum for multiple Pediatric Enrollees. Dental Service Category PPO1 Dental Plan2 Enrollee2 Diagnostic and Preventive Services 100% 0% Basic Services 50% 50% Major Services 50% 50% Medically Necessary Orthodontic Services (requires prior authorization) 50% 50% Waiting Periods No Waiting Periods
To Whom Benefits Are Paid. Any payment for Accidental Death becoming due hereunder shall be payable to the beneficiary of record, who shall be the legal beneficiary designated in writing and on file with the Company. If no such designation is then effective, such indemnity shall be payable to the estate of the Insured Person. Any other accrued indemnities, may, at the option of the Company, be paid either to the Insured Person, if living, or the estate of the Insured Person. Any payment made by the Company in good faith pursuant to this provision shall fully discharge the Company to the extent of the payment.
To Whom Benefits Are Paid. Payment for services provided by a DPO Provider or a Premier Provider will be made directly to the Provider. Any other payments provided by this Contract will be made to the Primary Enrollee unless the Primary Enrollee requests when filing proof of loss that the payment be made directly to the Provider providing the services. All Benefits not paid to the Provider will be payable to the Primary Enrollee, to his/her estate, or to an alternate recipient as directed by court order except that if the person is a minor or otherwise not competent to give a valid release, Benefits may be payable to his/her parent, guardian or other person actually supporting him/her.
