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<br />~-~~-------- <br /> <br />~ ------- <br /> <br />- ----- <br />-~----- <br /> <br />-- ---~-- ~ <br /> <br />~ ~ ------ <br /> <br />4.9 <br /> <br />LIMITATIONS ON PROSTHODONTIC BENEFITS: <br /> <br />(a) <br /> <br />(b) <br /> <br />(c) <br /> <br />Prosthodontic appliances that were provided under any Delta <br />program, including but not limited to fixed bridges and partial or <br />complete dentures, will be replaced only after five years have <br />passed, unless Delta determines that there is such extensive loss of <br />remaining teeth or change in supporting tissues that the existing <br />appliance cannot be made satisfactory. Replacement of a <br />prosthodontic appliance not provided under a Delta program will be <br />made if it is unsatisfactory and cannot be made satisfactory. <br /> <br />Delta will pay the applicable percentage of the Dentist's Fee for a <br />standard cast chrome or acrylic partial denture or a standard <br />complete denture, up to a maximum fee allowance which is at least <br />the Prevailing Fee for a standard denture. (A "standard" complete <br />or partial denture is defined as a removable prosthetic appliance <br />provided to replace missing natural, permanent teeth and which is <br />constructed using accepted and conventional procedures and <br />materials.) The maximum allowance is revised periodically as <br />dental fees change. Any denture and/or related service for which <br />a charge is made which exceeds this allowance is an optional <br />service, and the patient is responsible for the portion of the Dentist's <br />fee which exceeds the Delta allowance. <br /> <br />Implants (materials implanted into or on bone or soft tissue), or <br />their removal, are not Benefits under this Contract. However, if <br />implants are provided in association with a covered prosthodontic <br />appliance, Delta will allow the cost of a standard complete or partial <br />denture toward the cost of the implant procedures and prosthodontic <br />appliances. If Delta makes an allowance toward the cost of such <br />procedures, Delta will not pay for any replacement placed within <br />five years thereafter. <br /> <br />4.10 ORTHODONTIC BENEFITS. Delta agrees to provide Orthodontic <br />Benefits in accordance with the Orthodontic Benefit Rider attached hereto <br />as Appendix C. <br /> <br />n_~___- u <br /> <br />13 <br /> <br />~--~----~--- <br /> <br />-- <br />