Right to Receive and Release Needed Information: Certain facts about dental coverage and services are needed to apply these COB rules and to determine benefits payable under This Plan and other Plans. The Company may get the facts it needs from or give them to other organizations or persons for the purpose of applying these rules and determining benefits payable under This Plan and other Plans covering you. The Company need not tell, or get the consent of, any person to do this. You, to claim benefits under This Plan must give the Company any facts it needs to apply those rules and determine benefits payable. Facility of Payment: If payments that should have been made under This Plan are made by another Plan, the Company has the right, at its discretion, to remit to the other Plan the amount the Company determines appropriate to satisfy the intent of this provision. The amounts paid to the other Plan are considered benefits paid under This Plan. To the extent of such payments, the Company is fully discharged from liability under This Plan. Right of Recovery: The Company has the right to recover excess payment whenever it has paid Allowable Expenses in excess of the maximum amount of payment necessary to satisfy the intent of this provision. The Company may recover excess payment from any person to whom or for whom payment was made or any other Company or Plans. If payments that should have been made under This Plan are made by another Plan, DDWA has the right, at its discretion, to remit to the other Plan the amount it determines appropriate. To the extent of such payments, DDWA is fully discharged from liability under This Plan. Notice to covered persons If you are covered by more than one health benefit Plan, and you do not know which is your Primary Plan, you or your provider should contact any one of the health Plans to verify which Plan is primary. The health Plan you contact is responsible for working with the other health Plan to determine which is primary and will let you know within 30 calendar days. CAUTION: All health Plans have timely claim filing requirements. If you, or your provider, fail to submit your claim to a secondary health Plan within the Plan’s claim filing time limit, the Plan can deny the claim. If you experience delays in the processing of your claim by the primary health Plan, you or your provider will need to submit your claim to the secondary health Plan within its claim filing time limit to prevent a denial of the claim. To avoid delays in claims processing, if you are covered by more than one Plan you should promptly report to your providers and Plans any changes in your coverage. In the event DDWA makes payments in excess of the maximum amount, DDWA shall have the right to recover the excess payments from the patient, the subscriber, the provider or the other plan. The two examples that follow explain how non-duplication of benefits works: Example 1: Assume a subscriber has satisfied the deductible on both the primary dental plan and the UDP. The individual receives services for a root canal (Class II benefit) that costs $350. The primary plan pays Class II benefits at 90% and would pay $315 ($350 x 90%). The UDP pays Class II services at 80% and would have paid $280 ($350 x 80%) if it were primary. As secondary payer, the UDP subtracts what the primary payer paid and pays the difference ($280 - $315 = $0 payment). Example 2: Assume the primary plan pays 50% for Class II benefits. The primary plan would pay $175 ($350 x 50%) for the root canal described in Example 1. As secondary payer, the UDP would pay $105 ($280 - $175). Claim Review and Appeal Confirmation of Treatment and Cost Confirmation of Treatment and Cost is a request made by your dentist to DDWA to determine your benefits for a particular service. This Confirmation of Treatment and Cost will provide you and your dentist with general coverage information regarding your benefits and your potential out-of-pocket cost for services. 2024-01-03000-BB 35 LG PPOL 20240101