Common use of Parts 160 and 164 Clause in Contracts

Parts 160 and 164. Loss of Eligibility Date. Eligibility of Employee shall terminate on the last day for which Premium is paid for them, or on n/a as specified by Company whichever occurs first. Eligibility of Dependents, including spouses, shall terminate at the same time or on the day they no longer qualify as a Dependent. Maximum Plan Allowance shall mean the amount payable for Services of Participating and Non- Participating Dentists, calculated by Delta Dental, for use in payment by it and by its Enrollees from claim charges submitted, on a regional basis, for a given Service by Dentists of similar training within the same geographical area blended by Delta Dental with dentist fee information from a number of other sources, including dentist fee filings, using various factors, subject to regulatory limitations and adjustment for extreme difficulty or unusual circumstances. Any adjustments made for regulatory limitations or for extreme difficulty or unusual circumstances shall be made in favor of the enrollee. National Provider File shall mean the file maintained by Delta Dental Plans Association listing maximum allowable amounts or equivalents per procedure, by product and network status used by Delta Dental Plans.