Maximum Plan Allowance definition

Maximum Plan Allowance or “MPA” means the total dollar amount allowed for a specific Benefit.
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Maximum Plan Allowance means the amount that a Delta Dental Premier Dentist agrees contractually to accept as full payment for covered procedures. The Maximum Plan Allowance is calculated as a percentile of billed fees.
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Maximum Plan Allowance means the lesser of the following:
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Examples of Maximum Plan Allowance in a sentence

  • ODS will use the Maximum Plan Allowance for the comparable code to price the claim.

  • It is usually a percentage of the Maximum Plan Allowance the Enrollee pays directly to the Dentist for covered Benefits after meeting any applicable deductible.

  • The Maximum Plan Allowance is determined by HDS as to each Covered Benefit.

  • If you go to a non-participating Dentist (not contracted with a Delta Dental plan), DDMO will make payment directly to you based on the applicable Maximum Plan Allowance for the non-participating Dentist.

  • You are not responsible for paying the participating Dentist any amount that exceeds the Delta Dental PPO or Delta Dental Premier Maximum Plan Allowance, whichever is applicable.

  • If the fee is not payable because of a deductible, annual maximum, waiting period or frequency limitation, the dentist may bill up to the Maximum Plan Allowance.

  • If the crown is benefited, the dentist is held to the Maximum Plan Allowance for the service.

  • You or Your means the member.* Services by Non Network providers are subject to the Allowed Amount including the Maximum Plan Allowance for Non Network Providers.

  • Given the limited existing data of the area, additional surveys were required to provide the necessary detail as part of the Pluto project approval.

  • Not all Premier Dentists are PPO Dentists; however, all Premier Dentists agree to accept Delta Dental’s Maximum Plan Allowance for each Single Procedure as payment in full.


More Definitions of Maximum Plan Allowance

Maximum Plan Allowance or “MPA” means the amount we will allow for each covered Benefit based on the lowest of:
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Maximum Plan Allowance. (or MPA) means the maximum amount Delta Dental will reimburse for a covered procedure. Delta Dental establishes the MPA for each procedure through a review of proprietary filed fee data and actual submitted claims. MPAs are set annually to reflect charges based on actual submitted claims from providers in the same geographical area with similar professional standing. The MPA may vary by the type of network Dentist.
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Maximum Plan Allowance means the total dollar amount allowed under the Contract for a specific Benefit. The Maximum Plan Allowance will be reduced by any Deductible and Coinsurance the Subscriber or Covered Dependent is required to pay.
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Maximum Plan Allowance or “UCR” means the amount determined by the applicable Delta Dental Plan as the highest amount allowed for a particular procedure, service, or item for the particular Dentist or service provider. The amount allowed for a particular Dentist or service provider depends on its, his or her participation status (e.g., PPO Dentist, Premier Dentist or Non-Participating Dentist).
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Maximum Plan Allowance means the most that a Provider is allowed to charge for a procedure. Delta Dental reviews the limits twice a year. Delta Dental reserves the right to increase or decrease fees for any procedure in its sole and absolute discretion.
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Maximum Plan Allowance means the lesser of the following: a. In the case of a Participating Delta Dental Premier Dentist:
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Related to Maximum Plan Allowance

  • Retirement allowance means the retirement payments to which a member is entitled.

  • emission allowance means a financial instrument as defined in point (11) of Section C of Annex I of Directive [new MiFID].

  • Annual Addition The sum of the following amounts allocated on behalf of a Participant for a Limitation Year, of (i) all Employer contributions; (ii) all forfeitures; and (iii) all Employee contributions. Except to the extent provided in Treasury regulations, Annual Additions include excess contributions described in Code Section 401(k), excess aggregate contributions described in Code Section 401(m) and excess deferrals described in Code Section 402(g), irrespective of whether the plan distributes or forfeits such excess amounts. Annual Additions also include Excess Amounts reapplied to reduce Employer contributions under Section 3.10. Amounts allocated after March 31, 1984, to an individual medical account (as defined in Code Section 415(l)(2)) included as part of a defined benefit plan maintained by the Employer are Annual Additions. Furthermore, Annual Additions include contributions paid or accrued after December 31, 1985, for taxable years ending after December 31, 1985, attributable to post-retirement medical benefits allocated to the separate account of a key employee (as defined in Code Section 419A(d)(3)) under a welfare benefit fund (as defined in Code Section 419(e)) maintained by the Employer.

  • Total Compensation means the cash and noncash dollar value earned by the executive during the Contractor’s preceding fiscal year and includes the following (for more information see 17 CFR 229.402(c)(2)):