Maximum Plan Allowance definition

Maximum Plan Allowance or “MPA” means the total dollar amount allowed for a specific Benefit.

Maximum Plan Allowance means the amount that a Delta Dental Premier Dentist agrees contractually to accept as full payment for covered procedures. The Maximum Plan Allowance is calculated as a percentile of billed fees.

Maximum Plan Allowance means the lesser of the following:

Examples of Maximum Plan Allowance in a sentence

• Maximum Plan Allowance (MPA) is the maximum amount that the Plan will reimburse providers.

• Maximum Plan Allowance (MPA) is the maximum amount that ODS will reimburse providers.

• Maximum Plan Allowance (MPA) is the maximum amount that Delta Dental will reimburse providers.

• Delta Dental PPO providers sign a supplemental agreement and are paid according to a Maximum Plan Allowance for PPO Dentists as defined below.

• ODS will use the Maximum Plan Allowance for the comparable code to price the claim.

• If the design infiltration rate is for proposed fill soils, the data obtained using the method described in Env-Wq 1504.14(g).

• Maximum Plan Allowance (MPA) The maximum plan allowance is the amount that Delta Dental will pay for a service, supply, or dental procedure.

• All Delta Dental Premier providers are considered Participating Dentists and are paid according to DDKS’ Participating Dentist Maximum Plan Allowance (MPA) as defined below.

• You are not responsible for paying the participating dentist any amount that exceeds the PPO or Premier Maximum Plan Allowance, whichever is applicable.

• You or Your means the member.* Services by Non Network providers are subject to the Allowed Amount including the Maximum Plan Allowance for Non Network Providers.

More Definitions of Maximum Plan Allowance

Maximum Plan Allowance or “MPA” means the amount we will allow for each covered Benefit based on the lowest of:

Maximum Plan Allowance means the total dollar amount allowed under the Contract for a specific Benefit. The Maximum Plan Allowance will be reduced by any Deductible and Coinsurance the Subscriber or Covered Dependent is required to pay.

Maximum Plan Allowance. (or MPA) means the maximum amount Delta Dental will reimburse for a covered procedure. Delta Dental establishes the MPA for each procedure through a review of proprietary filed fee data and actual submitted claims. MPAs are set annually to reflect charges based on actual submitted claims from providers in the same geographical area with similar professional standing. The MPA may vary by the type of network Dentist.

Maximum Plan Allowance or “UCR” means the amount determined by the applicable Delta Dental Plan as the highest amount allowed for a particular procedure, service, or item for the particular Dentist or service provider. The amount allowed for a particular Dentist or service provider depends on its, his or her participation status (e.g., PPO Dentist, Premier Dentist or Non-Participating Dentist).

Maximum Plan Allowance means the most that a Provider is allowed to charge for a procedure. Delta Dental reviews the limits twice a year. Delta Dental reserves the right to increase or decrease fees for any procedure in its sole and absolute discretion.