GROUP # 16067New York • December 9th, 2019
Jurisdiction FiledDecember 9th, 2019
THIS DELTA DENTAL PPO DENTAL SERVICE CONTRACT FOR EXPERIENCE RATED GROUPSOctober 1st, 2018
FiledOctober 1st, 2018DELTA DENTAL OF NEW YORK, INC. DELTA DENTAL PPO DENTAL SERVICE CONTRACT FOR EXPERIENCE RATED GROUPS TABLE OF CONTENTS PAGE ARTICLE I Definitions 1 ARTICLE II Enrollment 6 ARTICLE III Entitlement to Services 7 ARTICLE IV Administration of Claims for Services 7 ARTICLE V Coordination of Benefits 8 ARTICLE VI Payment for Covered Services 11 ARTICLE VII Exclusions and Limitations 12 ARTICLE VIII General Provisions 12 ARTICLE IX Reports and Records and Inspection Thereof 15 ARTICLE X Contract Renewal, Modification and Termination 16 ARTICLE XI Extent of Entire Contract 18 ARTICLE XII Cancellation of Existing Contracts 18 Schedule A Appendix A Addendum