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ADMINISTRATOR means Delta Dental Insurance Company ("Delta Dental"), operating as an Administrator in the state of Utah. Administrative functions described in the Contract and in this booklet may be performed by Delta Dental, as designated by ALPHA. The mailing address for Delta Dental is 12898 Towne Center Drive, Cerritos, California 90703. Payments should be mailed to Delta Dental Insurance Company, Dept. 0171, Los Angeles, CA 90084-0171.
APPLICANT means the individual contracting to obtain dental Benefits as the primary Enrollee. 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 ALPHA 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 ORTHODONTIST means a Dentist who specializes in orthodontics, 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, Contract Orthodontist 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.
DOMESTIC PARTNER means a person who has, together with the primary Enrollee, affirmed a domestic partnership through an affidavit of domestic partnership provided to DeltaCare USA.
EFFECTIVE DATE means the first day of the month following DeltaCare USA's timely receipt of Premium and the Enrollment and Payment
Authorization Form.
ELIGIBLE DEPENDENT means any dependent of a primary Enrollee who is eligible for Benefits as described in this booklet.
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 including the primary Enrollee and
Eligible Dependent(s).
PREAUTHORIZATION means the process by which ALPHA 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, periodontics, orthodontics, or pediatric dentistry. Specialist Services must be preauthorized by ALPHA.
USUAL FEE means the fee that an individual dentist most frequently charges for a
given dental service.
WE, US or OUR means ALPA or its Administrator, Delta Dental, as appropriate. |
