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<br />~- <br /> <br />___un u_~ ---- ~~-~---~- <br />~-- <br />~ ~U_~---- <br /> <br />n~~___~ ~ <br /> <br />ARTICLE 7 - CONDITIONS UNDER WHICH DELTA WILL PROVIDE <br />BENEFITS <br /> <br />7.1 <br /> <br />7.2 <br /> <br />7.3 <br /> <br />7.4 <br /> <br />7.5 <br /> <br />Benefits, unless otherwise provided in Article 4, are available from the <br />Eligibility Date of an Eligible Person. <br /> <br />An Eligible Person may choose the services of any licensed Dentist, but <br />neither Delta nor City of Redwood City guarantees the availability of any <br />particular Dentist. <br /> <br />Before Delta is obligated to approve and/or satisfy any claims under this <br />Contract, Delta is entitled to receive, to such extent as is lawful, such <br />information and records relating to attendance to or examination of or <br />treatment provided to an Eligible Person from any attending or examining <br />Dentist, or from hospitals in which a Dentist's care is provided, as may be <br />required in the administration of such claims, or to require that an Eligible <br />Person be examined by a dental consultant retained by Delta in or near his <br />or her community or residence. Delta agrees in every case to hold such <br />information and records as confidential. <br /> <br />For services provided by a California Dentist who is not a Participating <br />Dentist, Delta will not pay more than the lesser of the fees entered on the <br />Attending Dentist Statement reporting such services to Delta or the <br />Prevailing Fees, multiplied by the applicable percentage specified in <br />Article 4 for such services. However, if the Dentist discounts, waives, <br />rebates or does not use good faith efforts to collect some portion of the fees <br />entered on the Attending Dentist Statement from the Eligible Person, Delta <br />will not pay more than the applicable percentage (specified in Article 4) of <br />the lesser of (1) the fees entered on the Attending Dentist Statement, <br />reduced by the portion discounted, waived, rebated or not collected, or <br />(2) the Prevailing Fees, reduced by the portion discounted, waived, rebated <br />or not collected. <br /> <br />If a Dentist in another state or country who cooperates with Delta in the <br />administration of the Program provides dental services to an Eligible <br />Person, Delta will pay the applicable percentage specified in Article 4 of <br />fees charged, up to the Customary fee in California. <br /> <br />20 <br /> <br />-- ---- <br /> <br />~ ~-~-- <br /> <br />~ ~---~ ~ <br /> <br />n __nu---~- <br />