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ADMINISTRATOR means Delta Dental Insurance Company ("Delta Dental "), or other entity designated by Delta Dental, operating as an Administrator in the state of Florida. Administrative functions described in this Contract and in this booklet may be performed by the Administrator, as designated by Delta Dental. The mailing address for the Administrator is 12898 Towne Center Drive, Cerritos, California 90703-8579. The Administrator will answer calls directed to (800) 422-4234.
APPLICANT means the individual contracting to obtain dental Benefits. YOU or YOUR refers to the Applicant.
BENEFITS mean those dental services that are provided under the terms of this Contract and described in this booklet.
CONTRACT means this agreement between Delta Dental and the Applicant including the Enrollment and Payment Authorization Form; the attached schedules, and any appendices, endorsements or riders. This Contract constitutes the entire agreement between the parties.
CONTRACT DENTIST means a Dentist who provides services in general dentistry and who has agreed to provide Benefits to Enrollees under this Program.
CONTRACT SPECIALIST means a Dentist who provides Specialist Services and has agreed to provide Benefits to Enrollees under this Program.
CONTRACT TERM means the one-year period starting on the Effective Date and each annual renewal period during which the Contract remains in effect.
COPAYMENT means the amount charged to an Enrollee by a Contract Dentist or Contract Specialist for the Benefits provided under this Program.
DENTIST means a duly licensed Dentist legally entitled to practice dentistry at the time and in the state or jurisdiction in which services are performed.
EFFECTIVE DATE means the first day of the month following Delta Dental's timely receipt of Premium and the Enrollment and Payment Authorization Form.
EMERGENCY SERVICES means only those dental services immediately required for alleviation of severe pain, swelling or bleeding or immediately required to avoid placing the Enrollee's health in serious danger.
ENROLLEE means a person enrolled to receive Benefits.
PREAUTHORIZATION means the process by which Delta Dental determines if a procedure or treatment is a referable Benefit under the Enrollee's plan.
PREMIUM means the amount payable as provided in this Contract.
SPECIALIST SERVICES means services performed by a Dentist who specializes in the practice of oral surgery, endodontics, or periodontics.
WE, US or OUR means Delta Dental Insurance Company. |
