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This Program provides Benefits without regard to coverage by any other group
insurance policy or any other group health benefits program if the other policy
or program covers services or expenses in addition to dental care. Otherwise,
Benefits provided under this Program by specialists or Out-of-Network Dentists
are coordinated with such other group dental insurance policy or any group dental
benefits program. The determination of which policy or program is primary shall be
governed by the rules stated in the Contract.
If this plan is secondary, it will pay the lesser of:
- the amount that it would have paid in the absence of any other dental benefit
coverage, or
- the enrollee's total out-of-pocket cost payable under the primary dental benefit
plan as long as the benefits are covered under this plan.
An Enrollee must provide to Delta Dental and Delta Dental may release to or
obtain from any insurance company or other organization, any information about
the Enrollee that is needed to administer coordination of benefits. Delta Dental
shall, in its sole discretion, determine whether any reimbursement to an insurance
company or other organization is warranted under these coordination of benefits
provisions, and any such reimbursement paid shall be deemed to be Benefits under
this Contract. Delta Dental will have the right to recover from a Dentist, Enrollee,
insurance company or other organization, as Delta Dental chooses, the amount of any
Benefits paid by Delta Dental which exceeds its obligations under these coordination
of benefit provisions.
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