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ARTICLE III -- MONTHLY PAYMENT 3.01 The monthly Dues under this Contract, to be paid b~y ~l;~Jica,0~to,.CDS, at the. addr~es~ sh.o, wjo on the cQver page o~ this Contract, shall be as follows: The sum 03: ~z£.,o~ 3:or eac-n- eJ. 3.g~_DJ.e e~pJ. oyee 3.n unit 1 and the sum of $26.70 for each eligible employee in unit 2. Applicant agrees to bear the expenses of such payments without withholding or otherwise charging the Eligible Em- ployees for coverage of themselves or their dependents. 3.02 This Contract shall not be in effect until Initial Dues are received by CDS. Subsequent dues shall be payable on or before the fifth {Sth) day of each month thereafter. 3.03 In the event this Contract terminates for any reason, the Applicant shall be liable for all Dues earned but unpaid. 3.04 In the absence of an amendment mutually agreed upon between Applicant and CDS, no change in Dues rates shall be made during a Contract Term, except as provided in paragraph 3.05. 3.05 The Dues rates specified in this Contract are contingent upon the number of employees elig[bie under this Contract remaining reasonably constant during the Contract Term. In the event that the number of Eligible Employees during any three consecutive months drops below 90 percent of the total number of Eligible Employees as of the Effective Date or commencement of any Contract Term of this Contract, CDS ma,/, at its option, propose to Applicant two or more alternative adjustments in rates, benefits or copayments necessary to correct adverse group experience resultant from such reduction in size. Within thirty (30) days, Applicant will select one of said alternatives by written notice to CDS, or if Applicant fails to do so, CDS may select one Of said alternate adjustments in benefits and/or copayments by written notice to Applicant; and the Contract shall be thereby modified accordingly for all dental services there- after authorized by CDS. ARTICLE IV - BENEFITS PROVIDED, LIMITATIONs AND EXCLUSIONS 4.01 Subject to the limitations and exclusions hereinafter set forth, the following services are Benefits when provided by a Dentist and when necessary and customary as determined by the standards of generally accepted dental practice. 4.02 CDS shall pay or otherwise discharge 8 0 % of the Dentists' Usual, Customary and Reasonable fees or of the fees actually charged, whichever is less, for the following Diagnostic and Preventive Benefits: Diagnostic -- procedures to assist the Dentist in determining required dental treatment. Preventive -- prophylaxis (cleaning) topical application of fluoride solution space maintainers 4.03 LIMITATION ON DIAGNOSTIC AND PREVENTIVE BENEFITS: The following limitation applies to Diagnostic and Preventive Benefits: a) Routine oral examinations and prophylaxis treatment shall not be provided more than twice each in any twelve month period. b) Complete mouth x-rays (at least 14 films) are provided only once in a three-year period, unless special need is shown. Supplementary bite-wing (individual) x-rays are provided on request by the Dentist but not more than once every six (6) months. 4.04 CDS shall pay or otherwise discharge 8 0 % of the Dentist's Usual, Customary and Reasonable fees or of the fees actually charged, whichever is less for the following Basic Benefits: Oral Surgery - extractions and certain other surgical procedures, including pre- and post-operative care. Restorative -amaigam, synthetic porcelain and plastic restorations (fillings) for treatment of carious lesions (visible destruction of hard tooth structure resulting from the process of dental decay). Endodontic -- treatment of the tooth pulp. Peridontic - treatment of gums and bones supporting teeth. -5- 11 77 RET