25C - AGMT GROUP INSURANCE - Laserfiche WebLink

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ARTICLE 1 - DEFINITIONS These terms, when used in this Contract, mean the following: 1.1 Administrator - a third party entity designated by Delta Dental to perform administrative functions described throughout this Contract, including, but not limited to, the collection of premium and eligibility. 1.2 Benefits - those dental services that are available under the terms of this Contract as set out In Article 4. 1.3 Contract - this agreement between Delta Dental and the Contractholder Including the attached appendices. This Contract Is the entire Contract between the parties. 1.4 Contract Term - the period beginning on the Effective Date and ending on December 31, 2018, and each subsequent yearly period during which this Contract remains in effect. 1.5 Delta Dental PPO(5A) Dentist - a Dentist with whom Delta Dental has a written agreement to provide services at the in -network level for Enrollees in this Delta Dental PPO Plan. 1.6 Delta Dental PPO Dentist's Fee - the fee that a Delta Dental PPO Dentist has contractually agreed with Delta Dental to accept for treating Enrollees under this plan, or the Fee Actually Charged, whichever is less, for a Single Procedure. 1.7 Delta Dental PPO Dentist's Prevailing Fee - the fee for a Single Procedure that satisfies the majority of Delta Dental PPO Dentists, as determined by Delta Dental based upon confidential fee listing accepted by Delta Dental from Delta Dental PPO Dentists. 1.8 Delta Dental Dentist - a Dentist who has signed an agreement with Delta Dental or a. Participating Plan, agreeing to provide services under the terms and conditions established by Delta Dental or the Participating Plan. 1.9 Dentist - a duly licensed Dentist legally entitled to practice dentistry when and where services are provided. 1.10 Dependent - a Primary Enrollee's Dependent who is eligible for Benefits under Article 2 of this Contract. 1.11 Eligibility Date - the date an Enrollee's eligibility for Benefits becomes effective under the terms of this Contract. 1.12 Enrollee - a Primary Enrollee or Dependent who is eligible and enrolls for Benefits under Article 2 of this Contract, or a person ceasing to meet such conditions who chooses Continued Coverage as set out In Article 10, and for whom Delta Dental receives the appropriate monthly payment as set out In Article 3. 1.13 Enrollee Co -payment.- the portion of the Dentist's fees or allowances charged for Benefits that is the Enrollee's responsibility. 1.14 Fee Actually Charged - the fee for a particular dental service or procedure that a Dentist submits to Delta Dental on a claim form, less any portion of such fee that is discounted, waived or rebated, or which the Dentist does not use good faith efforts to collect. 1.15 Participating Plan - Delta Dental and any other member of the Delta Dental Plans Association with which Delta Dental contracts to assist It In administering the Benefits of this Contract. 2 25C-54