Maximum Contract Allowance

The reimbursement under the Enrollee’s benefit plan against which Dentegra calculates its payment and the Enrollee’s financial obligation. Subject to adjustment for extreme difficulty or unusual circumstances, the Maximum Contract Allowance for services provided by: 1) a Dentegra Provider is the lesser of the Submitted Fee or the Dentegra Provider’s Contracted Fee; or 2) a Non-Dentegra Provider is the lesser of the Submitted Fee or the Dentegra Provider’s Contracted Fee for a Dentegra Provider in the same geographic area.

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