25C - AGMT GROUP INSURANCE - Laserfiche WebLink

Home Browse Search

3.5 In addition to the amounts, If any, which Delta Dental withholds from payments to Dentists as provided In Delta Dental Dentists Rules, the Contractholder authorizes Delta Dental to deduct from each of Its monthly payments to Delta Dental 15.75% of such amount as compensation for Delta Dental's administration of this dental plan. 3.6 After the end of each Contract Term, the stabilization shall be calculated by Delta Dental from the Effective Date of the Contract. The following percentage of any positive amount ("plus stabilization") may be reflected In the calculation of the renewal rate for the succeeding Contract Term and/or may be used to offset the additional cost of Increased Benefits for the succeeding Contract Term. 25% for Contractholders with an average monthly enrollment of 100 to 199 Primary Enrollees 50% for Contractholders with an average monthly enrollment of 200 to 299 Primary Enrollees. 75% for Contractholder with an average monthly enrollment of 300 to 399 Primary Enrollees. 100% for Contractholders with an average monthly enrollment of 400 or more Primary Enrollees. Average monthly enrollment Is based on the 12 -month period preceding each renewal date of this Contract. Any negative or positive amount occurring during a Contract Term will be Included in the calculation of the stabilization during the succeeding Contract Term. Stabilization means the negative or positive amount of Premiums paid under this plan after deduction of claims paid, reserves for Incurred but unreported claims and Delta Dental's administrative charge. In no event, however, shall the plus stabilization or any part of it be returned to the Contractholder In a cash transaction and such amounts remaining upon termination of the Contract shall remain with Delta Dental. 3.7 In the event the Contractholder chooses to convert to a self-funded plan during or at the end of a Contract Term, the stabilization accumulated under this plan is combined with the reserves held for incurred but unreported claims, with the balance used to pay for claims and administration without regard to the date of service. 3.8 Except as provided in the next paragraph, an agreement between Delta Dental and the Contractholder Is required to change the Contractholder's Premium rates during a Contract Term. 3.9 During a Contract Term, if any government agency Imposes any new tax on Delta Dental based on the amount of Premiums payable or the number of persons covered under this Contract, or if the rate of any existing tax on the amount of Premiums or the number of persons covered under this Contract increases, the Premiums stated in this Article will increase by the amount of any such new or increased tax(es): 3.10 Premiums and eligibility may be adjusted retroactively by Delta Dental or the Contractholder, but such adjustments are limited to the three-month period prior to the most current month for which the Contractholder provides eligibility data. ARTICLE 4 - BENEFITS PROVIDED; LIMITATIONS AND EXCLUSIONS 4.1 Subject to the limitations and exclusions set forth below, the following services are Benefits when they are provided by a Dentist and when they are necessary and customary as determined by the standards of generally accepted dental practice. 6 25C-58