Fill-up the form to become our esteemed panel dentist
(We are empaneling only 9 dentists for a particular pincode area so,
Hurry Up...!
)
Empanelment of Dentist/Dental Clinic with Secure Dental Care Plan is voluntary and without any "Joining Fee"
Only Documentation/Legal/Portal Maintenance Fee applicable
Fields marked with * are compulsory
Name of Dentist* :
Sex* :
Male
Female
DCI Registration Number* :
BDS Passed in year* :
Name of College* :
College Located At* :
BDS/MDS* :
BDS
MDS
MDS Subject :
Clinic Since* :
Clinic Address* :
City/Taluka* :
District* :
Pincode* :
State* :
Mobile No* :
(for office use only. All communications will be made on this number)
Clinic Phone No. :
Email ID* :
Website :
Facebook Profile ID :
(Instruction: Login to your facebook home page, copy its URL from address bar and paste here)
Profile Photo
(upload profile photo to create positive impact)
:
Photo size should not exceed 300 KB
Treatment Charges
Normal (without discount) Rate Card
of routine dental procedures on which panel dentist agree to provide discount.
Write
NA
if you do not want to provide any discount on any particular procedure. Mention any other procedure & charges where you wish to provide discount. To keep uniformity, we recommend (not binding) quoting scaling charges as Rs. 600, 400, 200 respectively for 1
st
, 2
nd
, 3
rd
sitting.
Keep a copy of this filled-up Rate Card with you for reference.
{Consultation: Free, Discount on Scaling & IOPA: 50% on normal charges, Discount on other Treatment: up-to 20% on normal charges}
Note:
Treatment charges are not publicly visible on the website. They can be viewed only by the panel dentist and person registered with Secure Dental Care Plans (after entering the registration number)
SN
PROCEDURE
CHARGE (Rs)
SN
PROCEDURE
CHARGE (Rs)
1.
Check-up & Consultation*
27.
Complete Denture: Imported*
2.
Scaling- 1st sitting (app.20min.)*
28.
Veneer: Composite*
Scaling- 2nd sitting (app.15min.)*
29
Veneer: Porcelain*
Scaling- 3rd sitting onwards (app.10min)*
30.
Complete Denture: FlexibleM*
3.
Dental X-ray (IOPA)*
31.
Gingivectomy: Single tooth*
4.
GIC Filling: Adult*
32.
Gingivectomy: Per quadrant*
GIC Filling: Pediatric*
33.
Flap Surgery: Per quadrant
Bone Graft material charges extra*
5.
LC Composite: Class II*
34.
Flap Surgery: Full mouth
Bone Graft material charges extra*
6.
LC Composite: Class I,III,IV,V*
35
Extraction: Mobile Tooth*
7.
Silver Filling: Class I*
36.
Extraction: Firm Tooth*
8.
Silver Filling: Class II*
37.
Extraction: Complicated*
9.
Pit & Fissure Sealent*
38.
Extraction: Root Piece*
10.
Crown: Metal*
39.
Surgical Extraction Of Bony
Impacted Third Molar*
11.
Crown: Metal-Acrylic facing*
40.
Apisectomy (RCT extra)*
12.
Crown: PFM*
41.
Cyst Enucleation (RCT extra)*
13.
Crown: Full Ceramic*
42.
Temporary Filling*
14.
Crown: Zirconia*
43.
Recementation: Single tooth*
15.
Crown: Zirconia (LAVA)*
44.
Orthodontic T/t: Removable
(U & L Arch)*
16.
Root Canal Treatment: Anterior*
45.
Orthodontic T/t: Fixed*
17.
Root Canal Treatment: Posterior*
46.
Implant- Single with prosthesis*
18.
Root Canal Treatment: Pediatric*
47.
Post-Core: Pre-fabricated-Metal
(RCT extra)*
19.
Removal Partial Denture: Single*
48.
Post-Core: Fiber Post (FRC)
(RCT extra)*
20.
RPD: Additional Tooth*
49.
Post-Core: Custom made
(RCT extra)*
21.
Cast Partial Denture: Single*
50.
Bleaching: First Sitting*
22.
CPD: Additional Tooth*
Bleaching: Extra Sitting*
23.
RPD: Flexible*
51.
24.
RPD: Flexible- Additional Tooth*
52.
25.
Complete Denture: Regular*
53.
26.
Complete Denture: Imported*
54.
General Terms and Conditions for empanelment of Dentist/Dental Clinics for Secure Dental Care Plans: 1. Applicant dentist (hereafter mentioned as Dentist) must be a registered dental practitioner with at least 2yrs of work experience, must have all basic dental armamentarium required to run a dental clinic at present era, must provide all basic treatment to the patients which are deemed necessary and must follow all asepsis and sterilization protocol while treating patients. 2. Dentist must provide free dental check-up and consultation to the subscribers of Secure Dental Care Plans (SDCP) as mentioned on the website www.securedentalcare.com and also in Annexure-I. Dentist must provide discount on dental treatment to the subscribers of SDCP as per the subscriber’s eligibility mentioned on his/her SDCP registration card or as per the agreed Terms and Condition mentioned in the Service Agreement. 3. Dentist, his/her staff and all his/her visiting consultant dentist(s) must maintain professional ethics and dignity while treating patients registered with SDCP and must provide same care and time in treating them like other routine patients coming to their clinic. Failure to do so and frequent complaints from subscribers may lead to termination of empanelment of the dentist without any refund of empanelment fee or any other remuneration payable, if any. 4. Empanelment of the dentist remains free from time to time and need to renew on yearly basis by paying renewal fee as and when applicable from time to time. 5. To maintain transparency, the panel dentists need to declare in written the charges of routinely done dental treatment procedures at their clinic. Such declared treatment rate card will be displayed on our website and the same shall be displayed at their clinic or should be produced on demand by the subscribers of SDCP card holder while availing dental treatment. Panel dentist will give discount on such previously displayed treatment charges as per the eligibility of the SDCP card holder as as per the agreed terms of the Service Agreement. We suggest displaying fair low charges so as to attract more number of patients without compromising on the quality of the treatment or material used. 6. By filling this online application for empanelment with Secure Dental Care and cure Pvt.Ltd. the Dentist authorizes Secure Dental Care and Cure Pvt. Ltd., Secure Dental Care Plans or their representative(s) to use the panel dentist’s name, contact details and other details mentioned in the Application Form, to publish it on the official website or other publications or for branding and marketing and to make communication with them by telephone or by mail or any other medium available on Social Media. 7. Secure Dental Care and Cure Pvt. Ltd and Secure Dental Care Plans is merely the facilitator and accept no responsibility for any negligence or deficiency in services or any short comings on the part of any of the panel dental surgeons and/or any visiting doctor(s) at their clinic or any of their staff members. 8. Secure Dental Care and Cure Pvt. Ltd and Secure Dental Care Plans reserve all rights to modify the terms and conditions from time to time and the same shall be binding to all its Dentists and the Dentist agree to abide by the same. Dentists are advised to visit our website to know all recent updates. All panel dental clinics will be named and addressed as Secure Dental Care in all our communications and publication. 9. Secure Dental Care and Cure Pvt. Ltd and Secure Dental Care Plans reserves the right to accept, reject or cancel any or all empanelment of dentists or application of empanelment of dentist or renewal of empanelment of dentist without assigning any reason. 10. Within 15 days of filling the online application for empanelment available at www.securedentalcare.com , the Dentist will complete all the requirements of empanelment and corporate listing as communicated to the Dentist on email by Secure Dental Care and Cure Pvt. Ltd. or inform refusal to complete the same in written on email to securedentalcare@gmail.com . No refusal in written on email within 15 days of filling the online application for emapnelment by the Dentist will be considered as approval by the Dentist to proceed with the formalities of empanelment and corporate listing considering on the basis of the online application and online acceptance of the terms mentioned in the Service Agreement and also the Service Agreement and Treatment Charges that is received on email will be considered as accepted by the Dentist. Signing of the Service agreement, completion of pending documentation, recovery of Empanelment Fee (if applicable at the time of filling this online application) or any other payment due towards the Dentist will be adjusted latter during internal settlement between the Dentist and Secure Dental Care and Cure Pvt.Ltd. 11. Secure Dental Care and Cure Pvt. Ltd. is not a Insurance Company and Secure Dental Care Plans are not insurance product. 12. All matters are subjected to Chandrapur, Maharashtra jurisdiction only. SERVICE AGREEMENT This Service Agreement is entered into on the date of filling the online application for empanelment (available at www.securedentalcare.com ) Between The applicant dentist filling this online application for empanelment (with Secure Dental Care and cure Pvt.Ltd. through the website www.securedentalcare.com whose name is appeared in the online application against "Name of Dentist" and all other details that follows in the online application for empanelment (herein after referred to as “Providerâ€, which expression shall, unless repugnant to the context or meaning thereof, be deemed to mean and include all its subsidiaries and entire group companies, successors, representatives and permitted assigns) as party of the FIRST PART And Secure Dental Care and Cure Pvt, Ltd a Company incorporated under the provisions of the Companies Act, 1956 and having its registered office at Mul Road, Netaji Subhash Square, Chandrapur, Maharashtra – 442401 (hereinafter referred to as “SDCCPL†which expression shall, unless repugnant to the context or meaning thereof, be deemed to mean and include it's successors, affiliate and assigns) as party of the SECOND PART. WHEREAS 1.The Provider and SDCCPL are individually referred to as a "Party†or “parties" and collectively as "Party†or “parties". 2.SDCCPL is an aggregator/network provider of dental clinics and facilitating dental treatment at these clinics to individuals, companies and organizations and for this purpose intends to develop a network of service providers. It is understood between the parties that SDCCPL is not an insurance company and donot guarantee to refer patients/Beneficiary to the Provider. 3.Provider is engaged in providing the Dental treatment/services/ facilities and is desirous to join the said network to extend its facilities to Eligible Beneficiaries on the agreed terms and conditions, and SDCCPL is interested in providing its Beneficiaries with Dental treatment/ services/ facilities. 4.SDCCPL has on the basis of representation of the Provider, agreed to recognize and engage the Provider as an empanelled Dental treatment / service/ facility provider for providing their services. Definition A.Provider shall for all purpose mean a Dental Treatment/ service/ facility provider. B.Beneficiaries shall mean the person/s that is eligible to avail the Dental plans/scheme of SDCCPL directly or through its channel partners/corporate clients/strategic alliance/any other insurance company. C.Confidential Information includes all information (whether proprietary or not and whether or not marked as ‘Confidential’) pertaining to the business of SDCCPL or any of its subsidiaries, affiliates, employees, Companies, consultants or business associates to which the Provider or its employees have access to, in any manner whatsoever. NOW IT IS HEREBY AGREED AS FOLLOWS: ARTICLE 1: Term This Agreement shall be in force from the effective date of this Agreement, and shall be valid for a period of 3 Years (Term) unless terminated by either party as per provisions of Article 7 of this Agreement. Upon expiry of the said term, the Agreement shall be renewed automatically for the same term unless terminated by either party in writing. ARTICLE 2: Scope of Services 1. The Provider undertakes to provide the service in a precise, reliable and professional manner to the satisfaction of SDCCPL & in accordance with additional instructions issued by SDCCPL from time to time. 2. The Provider shall treat the Beneficiaries of SDCCPL at its dental clinic according to good business practice. 3. The Provider shall extend dental treatment/ services and / or benefits to the Beneficiaries of SDCCPL as mentioned in Annexure-I in more detail. 4. The Provider shall ensure that Dental treatment/ services/ facilities are extended to the Beneficiary with all due care and accepted standards. 5. The Agreement is subject to the detailed schedule of fees submitted by the Provider, which shall be reviewed and accepted by SDCCPL and/or its corporate client/partner/Insurance Company. 6. The Provider shall allow SDCCPL and/or its corporate client/partner/Insurance Company’s official to meet the Beneficiary. SDCCPL shall not interfere with the service delivery team of the Provider; however SDCCPL reserves the right to discuss the service delivery with the provider and/or provider’s team servicing the same. Further access to service records and bills prepared by the Provider shall be provided to SDCCPL and/or its corporate client/partner/Insurance Company on a case to case basis with prior appointment from the Provider. 7. The Provider shall also comply with future requirement of SDCCPL providing for standardized billing, service details, etc and if required under any statutory requirement both parties agree to review the same. 8. The Provider shall allow SDCCPL and/or its corporate client/partner/Insurance Company to conduct audits of the bills as and when deemed necessary by SDCCPL and/or its corporate client/partner/Insurance Company. Such audits shall be conducted by SDCCPL and/or its corporate client/partner/Insurance Company’s audit team upon prior intimation to the Provider. 9. For Beneficiary availing Cashless/re-imbursement benefit: Any other incidental services required by the beneficiary on his/her request and which is not covered by his corporate/employer/insurance company needs to be approved separately by his/her corporate/employer/insurance company and if it is not covered then the same will not be paid by the corporate/employer/insurance company and the Provider needs to recover it from the Beneficiary. 10.The Provider will provide space for displaying Hoarding/Banner/Poster/any other advertisement material of SDCCPL and/or its corporate client/partner/Insurance Company as and when requested by SDCCPL and/or its corporate client/partner/Insurance Company without any extra cost/fees. The Provider shall display posters and banners perspicuously so that people are able to understand that the Provider is empanelled Dental Care/Health provider of SDCCPL and/or its corporate client/partner/Insurance Company. Without getting any written permission/authority, the Provider will not display any Hoarding/Banner/Poster/any other advertisement material of SDCCPL and/or its corporate client/partner/Insurance Company. ARTICLE 3: Identification of Beneficiaries and Provider 1. Direct Beneficiaries of SDCCPL will be identified by the Provider on the basis of the Secure Dental Care Plans card issued to the Beneficiary bearing the logo and the wordings and/or a photo identity card and/or the methodology agreed upon by both the parties from time to time as the system evolves and becomes more digital. 2. SDCCPL’s corporate client/partner/Insurance Company: The Beneficiaries will be identified by the Provider on the basis of an ID card issued to the Beneficiary bearing the logo and the wordings of corporate/employer/insurance Company and/or a photo identity card and/or the methodology agreed upon by both the parties and which may evolve with time. 3. For the ease of the Beneficiary, the Provider shall display the recognition and promotional material, empanelled status, and procedures for availing the services, as supplied by SDCCPL and/or its corporate client/partner/Insurance Company, at prominent location, preferably at the reception and billing counter. The Provider also needs to inform their reception and billing staff about the procedures of availing the services. 4. Provider/Provider’s clinic/hospital will be named and addressed as Secure Dental Care for easy identification & branding and SDCCPL may use the same for getting more business through various initiatives. 5. Provider should also collect details such as, identity proof, Company identity card, and others/ or the methodology agreed as per utilization fields mutually agreed upon. ARTICLE 4: Compensation of Services 1. The Provider shall raise bills as per the charges submitted by the Provider on email or any other medium and is mutually agreed by both the parties and/or as documented in Annexure “I†of this Agreement. If the Provider agrees to provide services/ benefits without any financial benefit from the corporate client/partner/Insurance Company of SDCCPL, that will not invalidate this AGREEMENT for the lack of consideration as the primary consideration to the Provider being the market reputation as the beneficiary visiting the Provider. 2. If in case, the Provider wants to revise the schedule of charges, the Provider can do so in the month of April-May of the next year. The provider requires to provide at least 30 days prior written intimation to SDCCPL of the same during which SDCCPL shall evaluate and shall communicate to the Provider of any disagreement/dispute on the same, if any. In case, if both the parties fails to come to a consensus on the revised charges even after mutually discussing the same, the pre discussed/submitted rates would be applicable until the end of the term/ notice/ one month from written communication. In general, the schedule of the charges remains fixed for minimum 1 yr starting from 1st April and ending on 31st March (both days included). 3. Beneficiary enrolled directly with SDCCPL: Provider can accept payment directly from the beneficiary as per Annexure I, keeps the major portion of the payment with them and transfer the remaining amount to the SDCCPL as it’s operational & maintenance cost as per the mutual agreement. Where Beneficiary makes payment to SDCCPL, then SDCCPL keeps the part of the payment as its operational & maintenance cost and transfers the remaining amount to the Provider as per the mutual agreement. The Provider will make sure that the payment towards the dental treatment is fully paid by the Beneficiary either in advance or before completion of the treatment. SDCCPL donot compensate the Provider any discount benefit that is offered to the Beneficiary by the Provider. 4. Beneficiary coming from SDCCPL’s corporate client/partner/Insurance Company: For Cashless or re-imbursement of treatment cost, the payment is to be made by SDCCPL’s corporate client/partner/Insurance Company to SDCCPL account as per there norms, bill/invoice submitted by the Provider and limit for individual treatment charges set by the corporate entity and cashless/re-imbursement eligibility of the Benificiary. Once the amount is received by SDCCPL, SDCCPL keeps the part of the payment as it’s operational & maintenance cost and forwards the remaining amount to the Provider, within 15 days of receipt of amount, as per the mutual agreement and/or Annexure-I. For the payment directly made by the beneficiary beyond the maximum (pre-authorized) cashless/re-imbursement limit set by corporate client/partner/Insurance Company, the same will be governed by Article 4.4 mentioned above. It is the responsibility/duty of the Provider to check and confirm the eligibility of the Beneficiary for cashless/re-imbursement benefits, raise the bill, collect the amount directly from the Beneficiary as and when required (either in advance or before completion of the treatment). It remains the responsibility of the Provider to raise & submit the Bill/Invoice as per the requirement for cashless/re-emburshment claim settlement. 5. Mode and source of payment would be as per Annexure I, mutually agreed upon by both the parties and the Provider shall issue “No Due†certificate to SDCCPL and/or its corporate client/partner/Insurance Company at the end of every financial year during the tenure of this Agreement. The format of the same shall be communicated by SDCCPL and/or its corporate client/partner/Insurance Company on or before 15 days prior to the end of that Financial Year. 6. Service Tax and any other taxes as and when levied or imposed by the Government will get added to the bill / invoice / amount to be credited to the Provider by SDCCPL. In such situation, the format of the billing will be as per statutory requirements. ARTICLE 5: Declarations and Undertakings of a Provider 1. The Provider undertakes that they have obtained all the registrations/licenses/approvals required by law in order to provide the services pursuant to this Agreement and that the Provider have the skills, knowledge and experience required to provide the services as required in this Agreement. 2. The Provider undertakes to comply with all requirement of law in so far as these apply in accordance to the provisions of the law and the regulations enacted from time to time, by the local bodies or by the central or the state govt. 3. The Provider shall not enter into direct/indirect contract/agreement/MOU with any of the SDCCPL’s corporate client/partner/Insurance Company (entity) within 3 years of the expiry of this Service agreement or Termination of this Service Agreement [for any reason(s) within the Term], if they were not in direct/indirect contract/agreement/MOU with the said entity before signing this Service Agreement with SDCCPL. 4. The Provider declares that it/he/she has never committed a criminal offence which prevents it/him/her from practicing the respective services and no criminal charge has been established against it/him/her by a competent court or tribunal. ARTICLE 6: Relationship of the Parties Nothing contained herein shall be deemed to create between the Parties any partnership, joint venture or relationship of principal and agent or master and servant or employer and employee or any affiliate or subsidiaries thereof. Each of the Parties hereto agrees not to hold itself or allow its directors employees/agents/representatives to hold out to be a principal or an agent, employee or any subsidiary or affiliate of the other. ARTICLE 7: Termination 1. SDCCPL reserves the right to terminate this Agreement anytime with/without giving reason by sending an e-mail notification, if: a. The Provider violates any of the terms and conditions of this Agreement; or b. SDCCPL comes to know of wrong and fraudulent practices; or c. SDCCPL observes cases of over provisioning without adequate explanation. d. The provider insists to increase the negotiated and agreed rates subject to the clause 4.2. e. The Provider enters into similar agreement with any other body /institutes/ company/ association which works as an aggregator/network/facilitator of dental care services. However, Provider can be directly on panel or visiting consultant to any institution/hospital/factory/corporate/Insurance Company or any other body of similar nature which do not have any agreement with SDCCPL until the date of signing this Service Agreement. 2. This Agreement may be terminated by either party by giving one month’s prior written notice by means of email / registered letter or a letter delivered at the office and duly acknowledged by the other, provided that this Agreement shall remain effective with respect to all rights and obligations incurred or committed by the parties hereto prior to such termination. ARTICLE 8: Confidentiality This clause shall survive the termination/expiry of this Agreement. 1. Each party shall maintain confidentiality relating to all matters and issues dealt with by the parties in the course of the business contemplated by and relating to this Agreement. The Provider shall not disclose to any third party, and shall use its best efforts to ensure that its, officers, employees, keep secret all information disclosed, including without limitation, document marked confidential, medical reports, personal information relating to the beneficiary, and other unpublished information except as maybe authorized in writing by SDCCPL. SDCCPL shall not disclose to any third party and shall use its best efforts to ensure that its directors, officers, employees, sub-contractors and affiliates keep secret all information relating to the Provider including without limitation to the Provider’s proprietary information, process flows, and other required details. 2. The Provider authorizes SDCCPL and/or its corporate client/partner/Insurance Company to use the Provider’s name, contact details and other details to publish on the official website or other publications for branding and marketing and to make communication with them by telephone/SMS/email/any other electronic-social media. 3. In Particular the Provider agrees to: a) Maintain confidentiality and endeavor to maintain confidentiality of any persons directly employed or associated with Dental/Health services under this Agreement of all information received by the Provider or such other person by virtue of this Agreement or otherwise, including SDCCPL proprietary information, confidential information relating to beneficiary, medicals/test information whether created/ handled/ delivered by the Provider. Any personal information relating to the beneficiary received by the Provider shall be used only for the purpose of inclusion/preparation/ finalization of medical information/test reports for transmission to SDCCPL only and shall not give or make available such information/any documents to any third party whatsoever. b) Keep confidential and endeavor to maintain confidentiality by its officer, employees, staff, or such other persons, of information relating to Beneficiary, and that the information contained in these reports remains confidential and the reports or any part of report is not disclosed/ informed to the Insurance Agent / Advisor/ Third party under any circumstances. c) Keep confidential and endeavor to maintain confidentiality of any information relating to Beneficiary, and shall not use the said confidential information for research, creating comparative database, statistical analysis, or any other studies without appropriate previous authorization from SDCCPL. ARTICLE 9: Indemnities and other provisions 1. SDCCPL, its directors/employees and/or its corporate client/partner/Insurance Company will not be in any way held responsible for the outcome or quality of care provided by Provider. 2. SDCCPL, its directors/employees and/or its corporate client/partner/Insurance Company shall not be liable or responsible for any acts, omission or commission of the employees or staff of the Provider and Provider shall obtain professional indemnity policy on its own cost for this purpose. The Provider shall be responsible in any manner whatsoever for the claims, arising from any deficiency in the services or any failure in providing the services. 3. Notwithstanding anything to the contrary in this Agreement neither Party shall be liable by reason of failure or delay in the performance of its duties and obligations under this Agreement if such failure or delay is caused by acts of God, Strikes, lock-outs, embargoes, war, riots civil commotion, any orders of governmental, quasi-governmental or local authorities, or any other similar cause beyond its control and without its fault or negligence. 4. The Provider will indemnify, defend and hold harmless the SDCCPL, it’s directors/employees and/or its corporate client/partner/Insurance Company against any claims, demands, proceedings, actions, damages, costs, and expenses which SDCCPL, it’s directors/employees and/or its corporate Client / Partner / Insurance Company may incur as a consequence of the negligence of the Provider in fulfilling obligations under this Agreement or as a result of the breach of the terms of this Agreement by the Provider or any of its employees or staff. 5. The Provider will have the facility covered by proper indemnity policy including errors, omission and professional indemnity insurance and agrees to keep such policies in force during entire tenure of the Agreement. The cost/ premium of such policy shall be borne solely by the Provider. ARTICLE 10: Notices All notices, demands or other communications to be given or delivered under or by reason of the provisions of this Agreement will be in writing and delivered to the other Party: a) By registered mail; b) By courier; c) e-mail d) By facsimile; In the absence of evidence of earlier receipt, a demand or other communication to the other Party is deemed given a. If sent by registered mail, seven working days after posting it; and b. If sent by courier, seven working days after posting it; and c. If sent by facsimile, 2 working days after transmission. In this case, further confirmation has to be done via telephone & email. d. The notices shall be sent to the other Party to the above addresses (or to the addresses which may be provided by way of notices made in the above said manner). ARTICLE 11: Miscellaneous This Agreement together with any present and future Annexure attached hereto/terms &/or condition updated on www.securedentalcare.com or official portal of SDCCPL constitutes the entire Agreement between the parties and supersedes, with respect to the matters regulated herein, and all other mutual understandings, accord and Agreements, irrespective of their form between the parties. All Annexure shall constitute an integral part of the Agreement. All the annexure, mentioned in this agreement and other annexure which may be agreed upon via post and/or email are integral part of this Service Agreement. All present and future tie-up of SDCCPL with any corporate / organization / group / industry / Insurance Company and its financial transaction related to payment to the Provider for the dental treatment/service will be as per this Service Agreement and/or Annexure-I and other future Annexure and will be shared with Provider from time to time. 1. Except as otherwise provided herein, no modification, amendment or waiver of any provision of this Agreement will be effective unless such modification, amendment or waiver is approved in writing or on email by SDCCPL. 2. Should specific provision of this Agreement be wholly or partially not legally effective or unenforceable or later lose their legal effectiveness or enforceability, the validity of the remaining provisions of this Agreement shall not be affected thereby. 3. The Provider will not assign, transfer, encumber or otherwise dispose of this Agreement or any interest herein without the prior written consent of SDCCPL. SDCCPL may assign this Agreement or any rights, title or interest herein to an Affiliate without requiring the consent of the Provider. 4. The failure of any of the parties to insist, in any one or more instances, upon a strict performance of any of the provisions of this Agreement or to exercise any option herein contained, shall not be construed as a waiver or relinquishment of such provision, but the same shall continue and remain in full force and effect. 5. SDCCPL do not directly pay to the Provider (from its own account and source) any money towards the treatment of any of the Beneficiary/patients or pay to the Provider to compensate for the discount extended to any of the Beneficiary/Patient. As per the mentioned Terms in this Service Agreement, SDCCPL extends the cashless/remuneration amount to the Provider which SDCCPL receives from its corporate client/partner/Insurance Company for the treatment of their Beneficiary at the center of the Provider. 6. SDCCPL may keep annual maintenance/renewal charges/fee for the Provider which will be informed from time to time and the Provider agrees to pay the same. Any such payment made/to be made during/before signing this Service Agreement are non-refundable in nature unless otherwise mentioned. 7. It is the responsibility of the Provider to inform SDCCPL about any changes in their e-mail ID, contact number or clinic address so as to timely receive any notification circulated by SDCCPL/corporate. 8. Provider will always keep arrangement ready to accept appointment through digital mode and process the requirements of the corporate partners of SDCCPL to process the pre-authorization or claim settlement at his/her center. 9. Law and Arbitration i. The provisions of this Agreement shall be governed by, and construed in accordance with Indian law. ii. Any dispute, controversy or claims arising out of or relation to this Agreement or the breach, termination or invalidity thereof, shall be settled by arbitration in accordance with the provisions of the Indian Arbitration and Conciliation Act, 1996. iii. The arbitrary tribunal shall be composed of One arbitrator to be appointed by SDCCPL. iv. The place of arbitration shall be the city of Head Office of SDCCPL and any award whether interim or final, shall be made, and shall be deemed for all purposes between the parties to be made in the city of Head Office of SDCCPL. v. The arbitrary procedure shall be conducted in the English and any award shall be rendered in English. The procedural law of the arbitration shall be Indian law. vi. The award of the arbitrator shall be final and conclusive and binding upon the Parties. vii. The rights and obligations of the Parties under, or pursuant to, this Clause including the arbitration Agreement in this Clause, shall be governed by and subject to Indian law. viii. The cost of the arbitration proceeding would be borne by the Provider. ARTICLE 12: Severability The invalidity or enforceability of any provisions of this Agreement in any jurisdiction shall not affect the validity, legality or enforceability of the remainder of this Agreement in such jurisdiction or the validity, legality or enforceability of this Agreement, including any such provision, in any other jurisdiction, it being intended that all rights and obligations of the Parties hereunder shall be enforceable to the fullest extent permitted by law. ANNEXURE- I I. Scope of Services: Dental Treatment as per the Schedule of Treatment / Procedure Charges submitted by the provider or as informed by SDCCPL to the Provider if the Provider fails to complete the requirements of empanelment and corporate listing within 15 days of filling this online application or fails to deny and inform the refusal to comple the same in written on email. On the treatment/procedure charges submitted by the Provider or informed to the Provider by SDCCPL, the Provider agrees to extend the following benefits directly to the Beneficiary or to SDCCPL and/or its corporate client/partner/Insurance Company: 1. 4 FREE Consultation 2. 50% discount on Scaling & IOPA radiograph 3. 20% discount on all dental treatment except where “Not Applicable†(NA) is mentioned. SDCCPL then either extend the whole benefit or no benefit or part of it to the Beneficiary as per the norms/MOU of SDCCPL with its Beneficiary or corporate client/partner/Insurance Company and the benefits extended to them is mentioned on the SDCP Card issued to the Beneficiary or notified to the Provider on email from time to time or will be available on the digital system as it evolves with time. The difference (in terms of Rupees) in the benefit committed by the Provider to SDCCPL and the actual benefits given to the Beneficiary on the treatment charges by the Provider is given to SDCCPL by the Provider as operational and maintenance cost for each Beneficiary. II. Process: - Beneficiary visits the Provider’s outlet/clinic/hospital. - The Provider identifies the beneficiary as mentioned in Article 3. - The service eligibility criteria are confirmed by the Provider (check Identity card and expiry date). - Dental Treatment/Offers/Discount benefit are extended to the Beneficiary based on the Scope of services and Compensation of Services as mentioned in Article 2 & 4. - Customer avails the cashless services or makes the payment at the service provider's outlet as mentioned in Article 4. - For cashless or re-imbursement cases, procedure to be followed is informed to the Provider from time to time as per the different norms of SDCCPL’s different corporate client/partner/Insurance Company. Utilization statistics along with the invoices shall be shared by Provider with SDCCPL’s corporate client/partner/Insurance Company as agreed by both the parties, and necessary payment to the Provider shall be made by the corporate client/partner/Insurance Company as per the norms. - Provider agrees to make arrangement of computer, printer, internet etc.facility ready at his/her center/clinic for smooth and faster functioning of all procedure to serve the Beneficiary. III. Beneficiary: Identity proof: - UHID Card of Customer issued by the Insurance Company/Employer. - Secure Dental Care Plans Card issued to the Beneficiary - Print out of the mentioned documents with a valid ID proof (Customers Company ID card / PAN Card, Drivers License, etc) IV. Utilization Statistics (to be shared by Provider in hard copy & MS-Excel with the mentioned fields): A) For Beneficiary from Reliance General Insurance Company Limited (or as per the requirement) i. Date of Visit of Beneficiary/ Location ii.Name of Beneficiary iii. Unique code as per acknowledgement card (UHID no /voucher code) iv. Phone no vi. Invoice no v. Name on which the bill is made vii. Services availed viii. Actual cost of service ix. Discount extended x. Cost after discount B) For other SDCCPL’s corporate client/partner/Insurance Company, as mutually agreed upon from time to time and informed on email.
I declare that all the above mentioned details are true to the best of my knowledge.
I have read, fully understood the above mentioned terms and I agree to abide by the same
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