What Your Plan Pays Sample Clauses

What Your Plan Pays. Coverage: The coverage selected for your dental benefits program uses Delta Dental’s PPO network of Participating Dentists. This Delta Dental PPO network program allows you to go to any Dentist of your choice and receive a level of benefits for Covered Services, but you will generally receive the best value from your plan if you visit a Delta Dental PPO Dentist. For the purpose of determining applicable Out-of-Pocket Cost, only Delta Dental PPO Dentists shall be deemed to be “Plan Providers” under the Agreement. Only your payments to Delta Dental PPO Dentists shall accrue to the Out- of-Pocket Costs for Plan Providers as specified in your Schedule of Benefits. Your plan’s payment is based on the “allowed charge” for a Covered Service received. The allowed charge is determined by whether the provider of the services is a Delta Dental PPO Dentist, participates with Delta Dental as a Premier Dentist, or does not participate with Delta Dental.
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What Your Plan Pays. Coverage: The coverage for your dental plan uses Delta Dental’s PPO network of Participating Dentists. This plan allows you to go to any Dentist of your choice and receive a level of benefits for covered services. You will receive the best value from your plan if you visit a Delta Dental PPO Dentist. Delta Dental PPO Dentists are Participating Dentists who offer lower fees to their Delta Dental PPO patients. Delta Dental PPO Dentists are reimbursed by Delta Dental based on the lesser of the submitted charge or Delta Dental’s allowed charge for PPO Dentists in the area in which the services were provided. PPO Dentists agree to accept Delta Dental’s allowed charge for PPO Dentists as payment in full, and agree not to charge the difference between their fees and the amount paid by Delta Dental back to their Delta Dental patients. PPO Dentists are allowed to charge for Deductibles, Co-Payments, Coinsurance, or services not covered under your plan. SAMPLE You will also receive benefits if you choose to visit a Delta Dental Premier Dentist. Delta Dental Premier Dentists are reimbursed by Delta Dental based on the lesser of the Dentist’s charge or Delta Dental’s allowed charge for PPO Dentists in the area in which the services were provided. You will be responsible for the difference in the cost of services between the “allowed charge” (based upon Delta Dental’s allowance for PPO Dentists) and Delta Dental’s allowed charge for Premier Dentists, in addition to any Deductible, Co-payment, and Coinsurance. Premier Dentists agree to accept this allowance for Premier Dentists as payment in full and agree not to charge the difference between their fees and the Premier allowance back to their Delta Dental patients. Payments you make to Premier Dentists do not count toward the Maximum Out-of-Pocket (MOOP) for Pediatric Enrollees.
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Related to What Your Plan Pays

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