Benefits, Limitations and Exclusions i. Dental Benefits are payable only for covered services. The dental plan covers several categories of Benefits when a Dental Provider furnishes the services and when they are necessary and within the standards of generally accepted dental practice. Claims will be processed in accordance with the dental plan standard processing policies. Dentists (dental consultants) may be used to review treatment plans, diagnostic materials or prescribed treatments to determine generally accepted dental practices and to determine if treatment has a favorable prognosis. If you receive dental services from a Dental Provider outside the State of Florida, the Provider will be paid according to the dental network payment provisions for said state according to the terms of the Provider’s Contract.
Benefits, Limitations and Exclusions. This plan provides the Benefits described in the Schedules that are a part of this Contract. Benefits are only available in the state of Florida. The services are performed as deemed appropriate by your attending Contract Dentist.
Benefits, Limitations and Exclusions for additional information. Routine eye exams are limited to one visit per calendar year for children through the end of the month in which they turn 19, and one standard pair of child eyeglasses (lenses, and frames from a pre-selected group of frames).
Benefits, Limitations and Exclusions. Under the Delta Dental participating agreements with participating dentists, benefit claims are reimbursed based on the lesser of the dentist’s submitted fee for hisƒher services or the maximum allowable amount heƒshe has agreed to accept as payment for covered services in accordance with the Participating Dentist Agreement applicable to the plan. Participating dentists accept the maximum allowable amount as payment in full. Subscribers, participants, and beneficiaries are responsible only for any non−covered charges, deductible and co−payment amounts, and any charges over the plan maximum. The complete DDPOK Claim and Appeal Procedure manual shall be the governing policy of all claims and appeals, and shall be administered in accordance with the appendix(ices) attached and forming a part of this Plan Agreement by reference herein. Each Subscriber, dependent, and beneficiary, agrees to all benefit terms and conditions, limitations and exclusions, and other Plan benefit conditions as found herein and in the appendix(ices) attached and forming a part of this Plan Agreement by reference herein. The appendix(ices) defines substantially all of the benefit claims, limitations and exclusions utilized in the ordinary course of business; however, the complete benefit limitations and exclusions of this Plan may change from time to time in conjunction with new guidelines for dental care and the profession of dentistry, as approved by DDPOK’s Board of Directors to be used in processing treatment plans for predetermination of benefits and for claim adjudication payment. In order to be apprised of the current, complete benefit limitations and exclusions for this Plan, please contact Delta Dental Plan of Oklahoma, Customer Service Department, P.O. Box 54709, Oklahoma City, Oklahoma 73154. If a Subscriber, participant, or beneficiary obtains treatment from a dentist who has not signed a participating agreement with Delta Dental, any benefit payment will be paid directly to the Subscriber, or to other participant or beneficiary if required by law, and will be based on the Benefit Payment provisions set forth in the appendix(ices) attached and forming a part of this Plan Agreement by reference herein. Each Subscriber, participant, or beneficiary is responsible for paying the dentist and for filing their own claims. The complete DDPOK Claim and Appeal Procedure manual shall be the governing policy of all claims and appeals, and shall be administered in accordance with the ap...
Benefits, Limitations and Exclusions. Under the Delta Dental participating agreements with participating dentists, benefit claims are reimbursed based on the lesser of the dentist’s submitted fee for his or her services or the maximum allowable amount for participating dentists. Participating dentists accept the amount that Delta Dental determines to be the maximum allowable amount as payment in full. Subscribers, participants, and beneficiaries are responsible only for any non−covered charges, deductible and co−payment amounts, and any charges over the plan maximum. The complete Claim and Appeal Procedure manual shall be the governing policy of all claims and appeals, and shall be administered in accordance with Appendix A. Each Subscriber, dependent, and beneficiary, agrees to all benefit terms and conditions, limitations and exclusions, and other Plan benefit conditions as found herein and in Appendix
Benefits, Limitations and Exclusions. Under the Delta Dental participating agreements with participating dentists, benefit claims are reimbursed based on the lesser of the dentist’s submitted fee for his or her services or the maximum allowable amount for participating dentists. Participating dentists accept the amount that Delta Dental determines to be the maximum allowable amount as payment in full. Subscribers, participants, and beneficiaries are responsible only for any non-covered charges, deductible and co-payment amounts, and any charges over the plan maximum. The complete Claim and Appeal Procedure manual shall be the governing policy of all claims and appeals, and shall be administered in accordance with Appendix A. Each Subscriber, dependent, and beneficiary, agrees to all benefit terms and conditions, limitations and exclusions, and other Plan benefit conditions as found herein and in Appendix Tulsa County CONFIDENTIAL Self-insured Administrative Services Agreement July 2023
