Laserfiche WebLink
ARTICLE 1 - DEFINITIONS <br />These terms, when used in this Contract, mean the following: <br />1.1 Administrator - a third party entity designated by Delta Dental to perform administrative <br />functions described throughout thls Contract, including, but not limited to, the collection of <br />premium and eligibility, <br />1.2 Benefits - those dental services that are available under the terms of this Contract as set out <br />In Article 4, <br />1.3 Contract - this agreement between Delta Dental and the Contractholder Including the <br />attached appendices. This Contract Is the entire Contract between the parties, <br />1.4 Contract Term - the period beginning on the Effective Date and ending on December 31, <br />2018, and each subsequent yearly period during which this Contract remalns In effect. <br />1.5 Delta Dental PPOOMI Dentist - a Dentist with whom Delta Dental has a written agreement <br />to provide services at the in -network level for Enrollees In this Delta Dental PPO Plan. <br />1.6 Delta Dental PPO Dentist's Fee - the fee that a Delta Dental PPD Dentist has contractually <br />agreed with Delta Dental to accept for treating Enrollees under this plan, or the Fee Actually <br />Charged, whichever is less, for a Single Procedure. <br />1.7 Delta Dental PPO Dentist's Prevailing Fee - the fee for a Single Procedure that satisfies <br />the majority of Delta Dental PPO Dentists, as determined by, Delta Dental based upon <br />confidential fee listing accepted by Delta Dental from Delta Dental PPO Dentists, <br />1.8 Delta Dental Dentist - a Dentist who has signed an agreement with Delta Dental or a. <br />Participating Plan, agreeing to provide services under the terms and conditions established by <br />Delta Dental or the Participating Plan. <br />1.9 Dentist - a duly licensed Dentist legally entitled to practice dentistry when and where <br />services are provided, <br />1.10 Dependent - a Primary Enrollee's Dependent who is eligible for Benefits under Article 2 of <br />this Contract. <br />1,11 Eligibility Date - the date an Enrollee's eligibility for Benefits becomes effective under the <br />terms of this Contract. <br />1.12 Enrollee - a Primary Enrollee or Dependent who Is eligible and enrolls for Benefits under <br />Article 2 of this Contract, or a person ceasing to meet such conditions who chooses Continued <br />Coverage as set out In Article 10, and for whom Delta Dental receives the appropriate <br />monthly payment as set out In Article 3. <br />1.13 Enrollee Co -payment.- the portion of the Dentist's fees or allowances charged for Benefits <br />that Is the Enrollee's responsibility. <br />1.14 Pee Actually Charged - the fee for a particular dental service or procedure that a Dentist <br />submits to Delta Dental on a claim form, less any portion of such fee that is discounted, <br />waived or rebated, or which the Dentist does not use good faith efforts to collect. <br />1.15 Participating Plan - Delta Dental and any other member of the Delta Dental Plans <br />Association with which Delta Dental contracts to assist it in administering the Benefits of this <br />Contract. <br />2 <br />25C-54 <br />