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<br />---- <br /> <br />~ ---- -~ ~ <br /> <br />~ ----- - <br /> <br />-- --~ <br /> <br />----- u~-~ <br /> <br />APPENDIX C <br /> <br />ORTHODONTIC BENEFIT RIDER <br /> <br />EFFECTIVE: February 1, 1998 <br /> <br />In consideration of the payments specified in paragraph 3.1 of the attached <br />~ Contract, and subject to all of the terms and conditions thereof, except as herein <br />otherwise specified, Delta agrees to provide Orthodontic Benefits to Eligible <br />Persons, as follows: <br /> <br />1. <br /> <br />Orthodontics are defined as the procedures performed by a licensed Dentist, <br />involving surgical repositioning of the teeth or jaws in whole or in part <br />and/or the use of an active orthodontic appliance and post-treatment <br />retentive appliances for treatment of malalignment of teeth and/or jaws <br />which significantly interferes with their function. <br /> <br />2. <br /> <br />Delta will payor otherwise discharge 60% of the lesser of the Usual, <br />Customary and Reasonable fees or of the fees actually charged for <br />Orthodontics. <br /> <br />3. <br /> <br />The lifetime maximum amount payable by Delta for all Orthodontics <br />rendered to each Eligible Person shall be $600.00, and the limitations on <br />maximum amounts payable during a calendar year, if any, specified in the <br />attached Agreement, shall not apply to Orthodontics. <br /> <br />4. <br /> <br />EXCLUSIONS AND LIMITATIONS: In addition to Exclusions and <br />Limitations stated in Article IV to the attached Contract, the following <br />exclusions and limitations shall apply to Orthodontic Benefits: <br /> <br />(a) <br /> <br />The obligation of Delta to make payments for an Orthodontic <br />treatment plan begun prior to the Eligibility Date of the patient shall <br />commence with the first payment due following the patient's <br />Eligibility Date. The above-mentioned maximum amount payable <br />will apply fully to this and subsequent payments. <br /> <br />1 <br />