Agmt74 California Dental Servic - Laserfiche WebLink

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3. (a) If an eligible patient is eligible for coverage under two or more CDS dental care programs, and more than one of said programs provide coverage for a particular service, CDS will pay the aggregate sum payable under all applicable programs, but not more than the lesser of the usual, customary and reasonable fee or the fee actually charged for such service and will prorate the cost thereof between the applicable programs, provided, that no program shall be charged with a greater amount than the amount for which it would be liable if such dual coverage did not exist. (b)lf an eligibie patient is entitled to coverage under one or more insurance policies or prepaid health care plans other than a CDS dental care program, then the benefits of this Agreement shall be provided only to the extent that the funds obtained from such other insurance or plan are inadequate to provide full payment for the services which are bene- fits provided by this Agreement. (c) If an eligible patient is injured through the act or omission of another person CDS shall provide the benefits of this Agreement only on condition that the eligible patient shall agree in writing: (i) To reimburse CDS to the extent of such benefits immediately upon collection of damages by him, whether by action at law, settlement or otherwise, and, (ii) To grant CDS a lien, to the extent of such benefits on any such action at law, settlement or right to recovery. (d)ln no event shall the provisions of this pal~a~raph ;3 operal~ to in~'ease the liability of CDS beyond the benefits for which it might otherwise be liable in the event 1~i~ paragraph did not apply. 4. Neither EMPLOYER nor CDS shall bailable f~r any act or omission by a dentist, his employees or agents, or any person performing dental or other professional services under ~ Agreement. 5. Participating dentists shall be obligated to schedule a~d rer~ler all dental treatment for eligible patients in accor- dance with the applicable standards of the der~tal pq3f~ i~.~ c~)mmurh~ty end to charge no more than the usual customary and reasonable fee therefor. CDS is authorized to e~(~l~l'e fi'om I:~ticipating in the services provided by this Agreement any dentist who persistently fail~ to co~'~ply with the ~Migations (~f participating dentists hereunder. 6. Any controversy or claim arising out of or relating to this AgreerJ~ent or the breach thereof, by or between either or both parties to this Agreement dentists eligible ~tients or any of t~m she be sett ed by arb trat on by a single a b~trator to be selected by the part,es, and judgmel~t' ul~ ~he aWat~l rendered by the arbitrator may be entered in any court having jurisdiction thereof. 7. In the event that any payment due pursuant to paragraph l(b) of General Agreements is not paid when due, CDS may give written notice that payment is due, and if such payment is not received within 10 days after such notice, COS may, at its option, terminate all further benefits and be released from all further obligations hereunder; provided, however, that CDS shall make payment to dentists for dental services authorized by CDS prior to termination and for dental services which are rendered without prior authorization by a dentist prior to receipt by him of notice of such termination of benefits. In the event of termination pursuant to this paragraph, EMPLOYER shall remain liable to COS for the full amount of all dentists' statements paid or otherwise discharged by CDS, plus Twenty-Five Percent (25%) of such amount (to compensate CDS for its administration of the dental program), less amounts actually paid by EMPLOYER to CDS. 8. Both parties to this Agreement agree to consult to the extent reasonably practical concerning all material published or distributed relating to this Agreement. No such material shall be published or distributed which is contrary to the terms of this Agreement. 9. Both parties to this Agreement agree to permit and encourage the professional relationship between dentist and patient to be maintained without interference. 10. If any portion of this Agreement or any Amendment thereof shall be determined by any arbitrator, court or other competent authority to be illegal, void or unenforceable, such determination shall not abrogate this Agreement or any portion thereof other than such portion determined to be illegal, void or unenforceable, and all other portions of this Agreement shall remain in full force and effect. 11. The parties agree that all questions regarding the interpretation or enforcement of this Agreement shall be governed by the laws of the State of California, where the Agreement was entered into and is to be performed.