Agmt74 California Dental Servic - Laserfiche WebLink

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RECITALS COS is a nonprofit corporation, organized and existing under Section 9201 of the Corporations Code of the State of California, composed of members licensed to practice dentistry under the provisions of the Dental Practice Act. It is the purpose of COS to provide dental care u~tder programs with responsible entities so as to maintain the prime requisites of an independent and responsible profession, i.e., fee for services, free choice of dentists and preservation of dentist-patient relationship without lay control, interference, promotion or commercialization. GENERAL AGREEMENTS 1. EMPLOYER agrees: (a)To compile, certify and furnish to CDS on or prior to the first of every month commencing on the commence- ment date of the term of this Agreement, a LIST OF ALL ELIGIBLE EMPLOYEES AND THEIR SOCIAL SECURITY NUMBERS entitled to receive dental benefits hereunder. Eligible employees shall be determined according to the Eligibility Rules - Appendix "A", attached hereto, (b)To pay COS monthly, commencing on the commencement date of the term of this Agreement, and on or before the first day of each succeeding month, the monthly payment specified in Section I-A of the Application for Dental Care Service Agreement. (c) To provide information to all eligible employees as to the existence and terms of this Agreement and the right of eligible patients to receive care as provided herein from a dentist of each patient's choice, as such choice may be exercised from time to time by a patient during the continued eligibility of the patient. (d)To advise eligible employees to notify their dentist at the time of their first appointment that they are covered by this Agreement and to provide their dentist with group identification and social security number. (e)To permit CDS, by its auditors or other authorized representati,/es, on reasonable advance written notice, to inspect records of EMPLOYER in order to verify the accuracy of lists of eligible employees prepared by EMPLOYER and submitted to CDS. 2. CDS agrees: (a)To advise participating dentists as follows: (i) To submit a treatment plan, prior to rendition of service, showing the patient's dental needs and the treatment necessary in the professional judgment of the dentist; and (ii) To notify the eligible patient of all actions taken by COS with respect to such treatment plans; and (iii) That such treatment plan need not be submitted prior to rendition of service in the case of emergency services or in the case of brief routine procedures. (b}To authorize such treatment plan for coverage under the dental care program provided by this Agreement when satisfied from the treatment plan and other data submitted by the dentist (1) that the patient is eligible hereunder; (2) that the services proposed are included in the Schedule of Services covered by this Agreement set forth in Appendix "C" attached hereto; and (3) that the total fees to be charged to both CDS and the eligible patient do not exceed the dentist's usual, customary and reasonable fees. Such authorization shall be for a reasonable period of time, but not longer thah the term of this Agreement. (c) To make no payment for any services rendered to a patient who is not eligible for dental care hereunder at the t;me of rendition of the service, except to the extent of services performed during a period of an authorization issued by CDS pursuant to subparagraph (b) of this paragraph, and except for completion of single procedures commenced at a time the patient was entitled to treatment by reason of such authorization. (d)To make periodic checks as to the adequacy of care provided by dentists through local dental consultants and cor~mittees of local dentists appointed by COS.