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Agmt74 California Dental Servic
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Agmt74 California Dental Servic
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Last modified
7/5/2005 2:53:21 PM
Creation date
6/10/2002 11:15:18 AM
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Template:
Agreement
Contractor Name
California Dental Service
PROJECT NAME
dental care service
RMP File Number
304
Date
2/1/1974
Reso Ref
7144
Box
2450
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APPENDIX "D" <br /> <br /> ORTHODONTIC BENEFIT RIDER <br /> <br /> In consideration of the payments specified in paragraph 1 of <br />the attached Agreement, and subject to all of the terms and <br />conditions thereof, except as herein otherwise specified, CDS <br />agrees to provide Orthodontic Benefits to eligible patients, <br />as follows: <br /> <br /> 1. Orthodontics are defined as the necessary procedures of <br />treatment by a licensed dentist for correction of malposed <br />teeth of eligible employees and their eligible dependents <br />as defined in Appendix "A". <br /> <br /> 2. CDS will pay or otherwise discharge 60% of the lesser of <br />the usual, customary and reasonable fees or the fees actually <br />charged for Orthodontics, provided that the amount payable to <br />a dentist who is not a participating dentist shall not exceed <br />60% of the amounts for the corresponding services set forth in <br />the Orthodontic Table of Allowances, a copy of which is <br />attached hereto, marked Exhibit 1 and incorporated herein by <br />reference. <br /> <br /> 5. The maximum amount payable by CDS for Orthodontics <br />rendered to an eligible patient shall be $600, and the limitations <br />on maximum amounts payable during a calendar year, as specified <br />in the attached Agreement, shall not apply to Orthodontics. <br /> <br /> 4. EXCLUSIONS. In addition to the Exclusions and Limitations <br />stated in Appendix C to the attached Agreement, the following <br />exclusions shall apply to Orthodontics: <br /> <br /> Ca) The obligation of CDS to make monthly or other <br />periodic payments for an orthodontic treatment plan will cease <br />upon termination of treatment for any reason prior to completion <br />of the case. <br /> <br /> (b) The obligation of CDS to make monthly or other periodic <br />payments for an orthodontic treatment plan begun prior to the <br />eligibility date of the patient will be caluculated on the <br />balance of the dentist's normal payment pattern remaining at <br />the patient's initial eligibility date. The above mentioned <br />maximum will apply fully to this amount. <br /> <br /> <br />
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