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ARTICLE I - DEFINITIONS For the purpose of this Contract, the following definitions shall apply: 1.01 "Applicant" means the Group or Employer for whose members or employees dental benefits are being provided. 1.02 "Eligible Employee" means any employee who meets the conditions of eligibility outlined in Article Il of this Contract. 1.03 "Eligible Dependent" means any of the dependents of an Employee who are eligible for benefits in accordance with the conditions of eligibility outlined in Article II of this Contract. 1.04 "Eligible Person" means an employee or a dependent who meets the conditions of eligibility outlined in Article II of this Contract. 1.05 "Eligibility Date" means the date an Employee's eligibility for Benefits becomes effective under the terms of this Contract. 1.06 "Contract" means this agreement between CDS and Applicant including the Application of the Applicant for this Contract and the attached appendices, endorsements and riders, if any. This Contract constitutes the entire Contract between the parties. 1.07 "Effective Date" means the date stated in the acceptance of Application for this Contract as made a part hereof. 1.08 "Contract Term" means the period commencing on the Effective date hereof and terminating on ~'e]3~'u,a~'_~ 2 8, '1 97 ~) . and each yearly period thereafter during which this Contract remains in effect. 1.09 "Contract Year" means the twelve-month period commencing on the Effective Date and each yearly period thereafter. 1.10 "Dent[st" means a duly licensed dentist legally entitled to practice dentistry at the time and in the place services are performed. 1.11 "Participating Dentist" means a licensed dentist who is a member of CDS and has agreed to provide services in accord- ance with terms and conditions established by CDS. 1.12 "Procedure Numbers" means the Procedure Numbers, shown on Appendix "B" which is attached hereto and made a part of this Contract. 1.13 Each of the words in the term "Usual, Customary and Reasonable" as used herein shall have the following meanings: USUAL - A usual fee is the fee regularly charged and received for a given service by an individua{ dentist, i.e. his own usual fee. If more than one fee is charged for a given service, the fee determined to be the usual fee shall not exceed the fee charged members of any group dental care program, other than a governmentally funded program. CUSTOMARY - A fee is customary when it is within the range of usual fees charged and received by dentists of similar training for the same service within the geographic area as determined by CDS, or the review committee, to be statistically relevant. REASONABLE - A fee is reasonable if it is "usual" and "customary", or if it falls above "custom- ary'' and is justifiable due to a level of treatment superior to that customarily provided in the dentist's geographic area. Additionally, a specific fee to a specific patient is reasonable if it is justi- fiable considering speciat circumstances, or extraordinary difficulty, of the case in question. 1.14 "Benefits" means those dental services which are available under the terms of this Contract as specified in Article IV. 1.15 "Single Procedure" means a dental procedure listed in Appendix 'B" to which a separate Procedure Number is assigned, e.g., a three-surface amalgam restoration of a single permanent tooth (Procedure 613) or a complete maxillary denture, including adjustments for a six-month period following installation (Procedure 700). 1.16 "Dues" means amounts payable monthly by Applicant as provided in Article Ill, Paragraph 3.01. 1.17 "Prevailing Fee" is the fee for a Single Procedure which satisfies the majority of dentists in California, as determined by CDS based upon confidential fee listings accepted by CDS from Participating Dentists. -3- 11-77 AD/R ET/PSE