Dental Insurance Agreement Sample Contracts

TO: Board of County Commissioners SUBJECT: Agreement – Delta Dental Plan of Oklahoma
Dental Insurance Agreement • May 15th, 2023

Submitted for your approval and execution is the attached agreement between the Board of County Commissioners on behalf of Tulsa County Human Resources and Delta Dental Plan of Oklahoma for dental insurance benefits plan beginning July 1, 2023 through June 30, 2024 as further described in the attached.

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AGREEMENT AND CONSIDERATION
Dental Insurance Agreement • October 15th, 2019

This Summary of Dental Plan Benefits should be read along with your Policy. Your Policy provides additional information about your Delta Dental plan, including information about plan exceptions and reductions. If a statement in this Summary conflicts with a statement in the Policy, the statement in this Summary applies to you and you should ignore the conflicting statement in the Policy. The percentages below are applied to Delta Dental's allowance for each service and it may vary due to the Dentist's network participation.*

Contract
Dental Insurance Agreement • March 20th, 2024
Delta Dental Contract For
Dental Insurance Agreement • February 28th, 2022 • Ohio
Dental terms of cover
Dental Insurance Agreement • May 31st, 2021

This document sets out the full terms and conditions of the contract between you, the policyholder, and us, the insurer (Unum Limited trading as Unum Dental). No alteration, modification or addition to these terms, or any waiver of these terms is valid unless otherwise stated in your policy schedule.

Comprehensive Dental with Orthodontia
Dental Insurance Agreement • August 9th, 2022

This benefit must be bargained into your collective bargaining agreement. Please refer to your collective bargaining agreement for specific details on what coverage you are eligible for or contact SEBF at 315-218-6513.

Dental Insurance Information and Agreement
Dental Insurance Agreement • December 2nd, 2022

One of our office goals is to assist you in maximizing your dental insurance benefits. As a courtesy to you, we will file the claim to your dental insurance carrier for services rendered. Please note that we have contacted your provider to verify benefits and were told that verification of benefits is not a guarantee of payment by your insurance company. Exact amount paid may differ from the verification amount provided. Please remember that the contract itemizing your dental benefits is an agreement between you, your employer, and your insurance carrier.Regardless of coverage, your estimated copayment for services is due the day of treatment. We try our best to give you the most accurate financial estimate, however if other claims are filed by another dentist without our knowledge, your annual maximum benefit or frequency allowed for certain procedures may be reached prior to our claim being considered.Please initial

Dental Insurance Agreement
Dental Insurance Agreement • February 7th, 2021

Dental insurance is rapidly playing a larger role in helping people obtain dental treatment. Since we strongly feel our patients deserve the best possible dental care we can provide, and in an effort to maintain this high quality care, we will give you the best possible estimate prior to treatment.

AGREEMENT
Dental Insurance Agreement • October 8th, 2021

As a courtesy to you, our patient, we will file your dental insurance claim forms with the following provisions. It is important to understand that the contract regarding your dental benefits is between you, your employer and your insurance company. The obligation you have with our practice is to pay for treatment, regardless of the amount that may or may not be reimbursed by your insurance company, as it is always an ESTIMATE.

AGREEMENT
Dental Insurance Agreement • April 5th, 2019

As a courtesy to you, our patient, we will file your dental insurance claim forms with the following provisions. It is important to understand that the contract regarding your dental benefits is between you, your employer and your insurance company. The obligation you have with our practice is to pay for treatment, regardless of the amount that may or may not be reimbursed by your insurance company, as it is always an ESTIMATE.

AGREEMENT
Dental Insurance Agreement • October 8th, 2024

As a courtesy to you, our patient, we will file your dental insurance claim forms with the following provisions. It is important to understand that the contract regarding your dental benefits is between you, your employer and your insurance company. The obligation you have with our practice is to pay for treatment, regardless of the amount that may or may not be reimbursed by your insurance company, as it is always an ESTIMATE.

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