|
} L fi Y# s 34+4+ t a J i7 #%rAIALrwrA 1�4+f A JL 0 V4L t •
<br />I�. +%ALJA%el a •L• 1..5+ri, 4■ .�-.� -... ... k- -
<br />..
<br />and all complaints received d from Members ��' regard a nature o professional services rendered. Any inquiries, complaints or
<br />GUAR: wr`itin or calling SAFEGUARD at the ' •es indicated in Paragraph ,a, and
<br />� Hike, shall � made to SAFE its Member
<br />�'I� rare '
<br />telephone number indicated in Paragraph .(a. SAFEGUARD has previously: made 'A.�A
<br />Services procedures.
<br />' Dependents who enroll in the Plan at the inception f this Comma and after Wining a list
<br />. For all Subscribers and pe
<br />. h ubs�ber and Dependent from RGAI UA` , SAFEGUARD shall issue are identification
<br />or other identifying) data for each � thereafter for
<br />card t each Member, identifying that Member as being eligible for service provided by this contract. Each month there
<br />new Members who enroll in
<br />e Plan and after ORGANIZATIONs notification to SAFEGUARD of said new Members
<br />enrollment, SAFEGUARD shah issue an identification card, as set forth abOvc. �
<br />4.5 On e Subscriber's enrollment form- each Eligible Participant or Dependent who i eligible to receive benefits ,
<br />�
<br />select the Dentist the Member wishes tog
<br />o to for services provided for herein. Whereafter, to obtain services, the Member reed
<br />only contact the selected Dentist
<br />. In the event a Member desires to transfer to another Dentist, the ember may do so by
<br />number cued in Paragraph a, and transfer to another Dentist listed herein,
<br />contacting SAMG�IRD at the telephone �
<br />effective the f`ust day of the following month. t ' d ays a weep. In the SAFE
<br />SAFEGUARD shall provide emergency dental services twenty -four (24) hours a day, m en
<br />' service area which is defined s being within twenty-five miles of the Member's selected
<br />event the Member � �n the Plan se � make �'s selected Dentist who will
<br />Dentist, and is in need of emergency denW services, the Member shall contact Me mbe
<br />reasonable armgements for such emergency h emer denW services. If the Member's Dentist is unavailable, the Member may obtain
<br />y
<br />i e from an licensed dentist. [upon verification of the unavailability of the Member's Dentist,
<br />emergency dental services y
<br />• Member for the cost of such emergency dental services, less any applicable Copa went s , up to a
<br />SAFEGUARD ��� reimburse the �e
<br />axum of fifty dollars .00. Expenses for covered benefits required iD a dental emergency, rendered by a licensed dentist
<br />outside the Plan service area which is defined as bein more than twenty -five (25) miles from the f ember's selected Dentists g WW
<br />be
<br />reimbursed to the Member, by SAFEGUARD, up to a maximum of fifty dollars (S50-00).
<br />is Contract emergency dente services means dental services rendered for the relief of per,
<br />As used within
<br />'
<br />bleeding or any condition ` which may result in disability or death only and where delay of treatment would be medically
<br />• e dental services required for such conditions and any further dental treatment or services
<br />inadvisable. the Plan covers only thus �
<br />• t Dentist. nest'eburserrent, the Member shall send a bill incurred s a result of
<br />must be provided by the Member's s selected Deng t � dress set f� in Paragraph a.
<br />dental emergency, maned aid, or other evidence of payment to SAFEGUARD at the ad
<br />such de p
<br />No claim forms are required to be submitted by the Member. ices to Members.
<br />. n SAFEGUARD shall maintain dental facilities at appropriate location to provide sere
<br />' establishment, maintenance and location of all dental facilities are within the sale discretion
<br />fRA�A'�'I� recognizes that e
<br />of SEAR and SAFEGUARD
<br />shall make the sole determination of the location and establishment of all such dental
<br />• • o promptly notify Members and RGAI� A� N in writing of the ten nin,ation s closure o any
<br />facilities. SAFEGUARD agrees t p y
<br />• ` * ' transfer Members to existing or alternate dental fclIities on this Benefit Pfau. A list of e
<br />participating dente f'acdt and to trans g d Dentist Dirctr�.
<br />names and addresses of the initial Participating Dentists for this Benefit Plan is attached mark
<br />V. DF
<br />JaIST-PAIMNIRELATIONSMP
<br />,5.1 It is expressly
<br />r understood that the relationship between the Member and the Dentist rendering services or txatment,
<br />d incident to the professional relationship, and SAFEGUARD's Peer Review
<br />shall be subject to the razes, limitations an privileges ember, without interference from SAFEGUARD or
<br />and Public Polley omittees, The Dentist shad be solely responsible to e M ,
<br />atment within the professional relationship. The Dentist have the right to refuse shall
<br />RAI��AI # for all services or tie
<br />treatment to a Member who continually fails to follow a Prescribed cou of treatme rat who uses the relationship for illegal
<br />purposes, or makes the professional relationship onerous. modem dental facilities available in the
<br />. • While SAFEGUARD desires and will actively seek to maintain the 1mOst of
<br />F at the operation and maintenance of the Dentists facility, equipment and the rendition
<br />profession} �t �s understood and agreed that � ` n f the Dentist,. including all authority and
<br />all professional services shall be solely and e�cclu�si�rely under a control and supervision , .
<br />of personnel, and operation of a professional prac�ce, and/or the mndrarn of anY
<br />control over the selection of staff, supervision � �
<br />particular professional service or treatment. ormed in
<br />undertake to see that the services provfded to Members b Dentists} shall be per`
<br />SAFEGUARD will n liable, prevailiu in e
<br />accordance with
<br />rofessional standards of reasonable competence and skill o dental practitioners} as app g
<br />community n which each Dentist practices.
<br />6.1
<br />'ve on the date indicated in Pararapb B of the Acceptance Agreement, and shall
<br />This ontxct sham be effect
<br />h of the Acceptance Agreement. Plan coverage "I commence n the
<br />continue to the end of a prod specified �n Paragraph P _
<br />i ted in Para ra h o the Acceptance Agreement, and shalt continue for the period se t forth in Para g
<br />raph of the
<br />date end � g
<br />Acceptance Agreement.
<br />
|