WHEREAS MyDentalPlan Healthcare Pvt. Ltd. (the “Company” which includes its permitted assigns and successors in interest) herein is engaged in the business of healthcare and as such is providing dental healthcare plans (“Plans”) to its various prospective as well as existing clients for the purposes of providing dental care and treatments/procedures etc. at the price as may be agreed by the Company with the such clients.

This Services Agreement (the “Agreement” which includes the addendums, instructions, manuals, communication’s sent by the Company to the Hospital/Clinic/Associate/Affiliate in connection with the services to be provided under this Agreement) is entered into for valuable consideration by and between the Company, and the person / entity listed above ( “Hospital/Clinic/Associate/Affiliate” which includes the employees, associates, partners, contractors, or any other individual’s / persons as may be engaged by the Hospital/Clinic/Associate/Affiliate for providing dental services) together referred to herein as the “Parties” and individually referred to as “Party”, for the Term (as set forth above) of this Agreement.

WHEREAS the Parties hereto are entering into this Agreement as under:

Highlights of the provider agreement-:

1. 1. MyDentalPlan has entered into a new exciting phase where multiple insurance companies who are designing insurance plans and sending patients to avail cashless and reimbursement claims through our Provider network.
   
2. 2. Provider Management Software (PMS) developed by M/s MyDentalPlan Healthcare Pvt. Ltd. (MDP) will be given to the provider to maintain the entire patient’s data / record and to do billings and online payment gateway to collect the amount for the treated procedures.
   
3. 3. For all Dental Insurance patients coming through MDP, Provider will first take prior Authorization from MDP through PMS. Accordingly, the procedures approved can be performed as cashless and the payments will be settled from MDP with-in 60 working days of submission of the bills.
   
4. 4. The fee / charges to the Hospital/Clinic/Associate/Affiliate Address will be as decided between the parties mutually and / or as per the MDP Portal. .
   
5. 5. The Provider has to collect all the payments only through on-line payment gateway provided by the MDP in the PMS and shall not receive any cash payments for MDP allotted patients.
   
6. 6. Provider has to collect any additional payment over and above what is authorized by the company from the concerned patient for the treated procedures as per what is specified in the MDP portal.
   
7. 7. Dentist have to mandatorily upload the Prescription along with findings, diagnosis & Treatment plan with sign, seal and Registration number to prevent misuse of reimbursement facilities or fraud and same physical prescription copy to be given to patient.
   
   
8. For detailed Provider Agreement please refer points below :
   
   

1. Services to be rendered. The Hospital/Clinic/Associate/Affiliate being duly qualified dentist engaged in the practice of dentistry, is desirous to provide dental services ("Service(s)") to individuals, persons, members, subscribers, corporate houses, and groups, enrolled the Company ("Clients"), and with the said intent the Hospital/Clinic/Associate/Affiliate and the Company hereto are entering into this Agreement with the terms and conditions set out herein. The details of the Hospital/Clinic/Associate/Affiliate and visiting specialists associated with the Hospital/Clinic/Associate/Affiliate as mentioned in the MDP portal/app.Annexure A
2. Requisite qualification of Hospital/Clinic/Associate/Affiliate. The Hospital/Clinic/Associate/Affiliate acknowledges and confirms that he and the employees, associates, partners, contractors, or any other individuals / persons engaged by him are holding requisite qualification, eligibility, permissions, approvals and licenses as are required under the law for the performance of their obligations / duties / jobs during the course of performing any act pursuant to this Agreement.
3. Non-Compete. The Hospital/Clinic/Associate/Affiliate herein, has not entered into any agreement similar to this Agreement with any person / company / firm etc., and shall also not enter into in future till the continuation of the Term of the Agreement.
4. Quality. The primary concern of Hospital/Clinic/Associate/Affiliate shall be the quality of the Services provided to the Clients, which are required to be as per the standards set by the Company. Nothing stated in this Agreement shall be interpreted to diminish this responsibility. The Hospital/Clinic/Associate/Affiliate shall provide all the Services by duly licensed, certified or otherwise authorized professional personnel and shall maintain high standards of discipline while abiding by all the norms, regulations, guidelines and applicable law. The Hospital/Clinic/Associate/Affiliate hereby assures that the Company that Services shall be provided to the Clients in the same manner and with the same quality and care, as are provided to any other patient in his clinic, subject to the requirements mentioned in this Agreement.
5. Provider Management Software. Provider Management Software ("PMS") developed by the Company shall be installed in the office / clinic of the Hospital/Clinic/Associate/Affiliate and the Hospital/Clinic/Associate/Affiliate shall always maintain the entire data / record of the Clients.
6. Additional payments. The Parties understand that there may arise a situation where the charges for the Health services rendered by the Hospital/Clinic/Associate/Affiliate may exceed the dental coverage of the Client. In such situations, the Hospital/Clinic/Associate/Affiliate shall collect the excess amount, over and above the dental coverage, from the Client on behalf of the Company . The Hospital/Clinic/Associate/Affiliate shall charge additional payments from the Client as per what is communicated by the Company in writing from time to time or as reflected on PMS billing system. The Company shall at its own discretion and without any interruption, solely perform administrative, accounting, enrollment, eligibility verification, fixation of charges / fees and other functions necessary for the administration and operation of any of its Plans.
7. Charges and collection thereof. The charges for the Health Services rendered by the Hospital/Clinic/Associate/Affiliate to the Client shall not exceed the amount(s) as set forth by the Company. The Hospital/Clinic/Associate/Affiliate shall receive complete payment of the charges / Co-payment through PMS and payment gateway and shall allow the discounts as may be required / communicated by the Company and no additional amount shall be charged. The Hospital/Clinic/Associate/Affiliate may receive payment in cash from the Client but only after recording the transaction in PMS. Here it is made clear that collection of the charges is not the responsibility of the Company and shall be paid by the Client directly to the Hospital/Clinic/Associate/Affiliate rendering the Service, through PMS and payment gateway orthrough cash. The Company shall not entertain or provide any claim forms from non-insurance patients and / or payments in lieu of any treatment rendered by the Hospital/Clinic/Associate/Affiliate. The bank details of the Hospital/Clinic/Associate/Affiliates are to be provided in the table annexed with this Agreement as Agreement as Annexure B.
8. Prior authorization of Company in certain cases. Hospital/Clinic/Associate/Affiliate will be seeing individuals who have dental insurance from either a part of medical insurance or some amount covered by their corporations with different limits of procedures covered and amounts. For these individuals, the Hospital/Clinic/Associate/Affiliate will first take prior authorization from the Company before, through PMS After receiving the approval, Hospital/Clinic/Associate/Affiliate will provide the requisite services and submit the claim form through PMS for reimbursement / fees, which will be made payable as and when received from the insurance company.
9. Benefits and premiums. The Company hereto shall solely be responsible for establishing benefits, premiums and co- payments and for interpreting the terms of and making final coverage determinations. Changes in any terminology or procedure codes shall not alter the scope of benefits, applicable co-payments, or services not covered. It is specifically understood by the Hospital/Clinic/Associate/Affiliate that the benefits, terms and conditions of the Plan may be changed from time to time during the term of this Agreement and that the Company may enter into agreements for new Plans during the term of this Agreement and that the Hospital/Clinic/Associate/Affiliate shall be required to provide Services to any number of new Clients enrolled by the Company.
10. Audit, Inspection and Fraud. The Company hereto shall solely be responsible for establishing benefits, premiums and co- payments and for interpreting the terms of and making final coverage determinations. Changes in any terminology or procedure codes shall not alter the scope of benefits, applicable co-payments, or services not covered. It is specifically understood by the Hospital/Clinic/Associate/Affiliate that the benefits, terms and conditions of the Plan may be changed from time to time during the term of this Agreement and that the Company may enter into agreements for new Plans during the term of this Agreement and that the Hospital/Clinic/Associate/Affiliate shall be required to provide Services to any number of new Clients enrolled by the Company. PMS, or any cash / unbilled transactions or any of the transactions / payments not processed through the gateway of the Company, shall be treated as fraud on part of the Hospital/Clinic/Associate/Affiliate and Hospital/Clinic/Associate/Affiliate shall be liable to pay the entire received amount related to the said payments / transaction. The Company shall be entitled to take appropriate action against the Hospital/Clinic/Associate/Affiliate under contract and law for such an unlawful act, including termination of this Agreement and expulsion from the Hospital/Clinic/Associate/Affiliate network.
11. Uploading of Treatment Information. Hospital/Clinic/Associate/Affiliate shall regularly, i.e., on completion of end of each day, upload all the details including the treatments rendered to the Clients, along with all the radiographs as well as all the details of charged money/ payments/ fees etc. to PMS. Any amount, if received by the Hospital/Clinic/Associate/Affiliate directly from the patient and is not reported to the Company will initiate a disciplinary action and may result in deactivation of that Hospital/Clinic/Associate/Affiliate.
12. Number of Clients. Nothing in this Agreement shall be construed to require the Company to send any minimum or maximum number of Clients to the Hospital/Clinic/Associate/Affiliate.
13. Affixation of Sign Board. The Hospital/Clinic/Associate/Affiliate shall allow the Company, for affixing the sign board of the Company, on their Clinic/Hospital.
14. Location, etc, of Clinic / Hospital. The clinic / hospital of the Hospital/Clinic/Associate/Affiliate should be easy to locate and its entrance should be well marked. The Hospital/Clinic/Associate/Affiliate's office / clinic / hospital shall be available to Clients of the Company at all times during working hours. Hospital/Clinic/Associate/Affiliate shall have less than three days accessibility available to the Clients and the waiting time shall generally not exceed 15 minutes. In case the Plan requires Hospital/Clinic/Associate/Affiliate to have a timely recall system for any Client, the said Client should be recalled within the specified time. Emergency patients shall be seen by the Hospital/Clinic/Associate/Affiliate only and on the same day.
15. Documentation related to Plan. Documents related to a particular Plan shall be furnished to the Hospital/Clinic/Associate/Affiliate by the Company from time to time either in hard copy or through electronic communications such as emails.
16. Individual Plans. Hospital/Clinic/Associate/Affiliate may sell individual plans from his office / clinic to any individual, when the Company, decides and authorizes the Hospital/Clinic/Associate/Affiliate to do so.
17. Liability of HOSPITAL/CLINIC/ASSOCIATE/AFFILIATE AGREEMENT. Hospital/Clinic/Associate/Affiliate shall always remain responsible for all the acts and liabilities whatsoever for the Services includes but not limited to the Services of dental treatment, provided under this Agreement.
18. Maintaining Proper Equipment, Safety Precautions, etc. Hospital/Clinic/Associate/Affiliate shall remain responsible for possessing all the dental / medical as well as other equipment and the same shall always be kept in good and well-maintained condition. The Hospital/Clinic/Associate/Affiliate shall maintain adequate staff and laboratory facilities. The Hospital/Clinic/Associate/Affiliate shall be responsible for taking adequate measures with respect to mercury safety and X-Ray or from any other harmful radiation as per applicable standards. Hospital/Clinic/Associate/Affiliate shall always keep and maintain the clinic / hospital well equipped and follow disinfection process from time to time. Hospital/Clinic/Associate/Affiliate shall always ensure measures for the Client's safety precautions, barrier techniques such as use of gloves, gowns, masks and eye protection covers/Barrier tape on chair and equipment for each patient. Hospital/Clinic/Associate/Affiliate shall take every precaution and follow norms regarding medical, infectious and every other kind of waste disposal. Hospital/Clinic/Associate/Affiliate shall always maintain its clinic / hospital in consonance with the applicable local municipal law with respect to building, construction, use of the premises, fire-fighting and other requirements / guidelines / norms.
19. Proper hygiene and cleanliness. Hospital/Clinic/Associate/Affiliate shall keep the exterior of the building well maintained, providing clean entrances and hallways. Proper hygiene shall be maintained in the clinic / hospital as per the applicable norms and standards. The waiting area must be comfortable, clean, and professional in appearance. It must have adequate seating and the office staff must exhibit a professional and courteous attitude towards the Clients.
20. Sterilization. Hospital/Clinic/Associate/Affiliate shall always use adequate and prescribed methods of sterilization as per the current prevailing norms and recent scientific recommendations. Hospital/Clinic/Associate/Affiliate will use biological monitors for the sterilization unit. Hospital/Clinic/Associate/Affiliate may, as per the requirement, use Autoclave / dry heat sterilizer / chemical soak / cold sterilization solution containing 2% glutaraldehyde solution. Hospital/Clinic/Associate/Affiliate shall take due care of verification of ultrasonic unit, verification of sealed, non-punctured, color indicator activated and dated sterilization bags for all surgical instruments, verification of sealed, non-punctured, color indicator activated and dated sterilization bags for all periodontal instruments, verification of sealed, non-punctured, color indicator sterilization bags for all basic, non-surgical instruments, verification of dated sterilization bags (30 day limit for sterilized seal), verification of utility glove use for sterilization, verification of tray breakdown procedures used by office staff.
21. No Unlawful Discrimination. Hospital/Clinic/Associate/Affiliate shall not unlawfully discriminate against any Client on the basis of source of payment or in any other manner in regard to access to, and the provision of, Services. Hospital/Clinic/Associate/Affiliate shall not unlawfully discriminate against any member, employee or applicant for employment on the basis of race, religion, color, national origin, ancestry, physical handicap, medical condition, marital status, age, sex or sexual orientation.
22. Patient Records. Hospital/Clinic/Associate/Affiliate shall maintain proper medical records and history of Clients as may be sent by the Company including the date of examinations / treatments / sittings etc., name of physician, phone number, date of last physical examination, and whether the Client is under physician care, nature of treatments or medications that the Client is given / advised / taking and the amount so charged in lieu of the same from the concerned Client. Pre-medication taken by the Client with antibiotics for dental treatment, Client's allergies to penicillin, tetracycline, sulfa drugs, aspirin, codeine, or other drugs, should be documented. Hospital/Clinic/Associate/Affiliate is also required to check if the Client has had heart surgery, joint replacement, or use of a cardiac pacemaker or, if the Client is pregnant and, if yes, its duration, or if the Client is taking birth control pills and has past history of menstrual problems. In addition to the above the Client record must show his dental history including date and reason of last dental treatment, reason of the Client's dental visit and the Client's major complaint, types of previous dental treatment complications, temporomandibular joint dysfunction history, sensitivity of teeth, current or past reaction to dental anesthetics or any other medical alert information. Hospital/Clinic/Associate/Affiliate shall maintain dental examination record of the Client providing his/her clinical observations including the information related to missing teeth, existing restorations and prosthetic appliances, their age and condition, defective restorations, oral cancer check, blood pressure readings, problems of temporomandibular joint dysfunction, problems with clenching, grinding of teeth, and/or clicking of jaw joints, evaluation of all soft tissues of the head, neck, palate, tongue, and lips, frequency of radiation based on national or state dental associations' recommendations, oral hygiene instructions, impacted teeth. Periodontal evaluations should be made at initial visit. Client's periodontal health should be assessed, pocket probing, tooth mobility, as well as moderate or advanced periodontal disease should be specified. The record of the Client should have a specific mentioning about periodontal probing, furcation, mobility, gingival recession, and gingival conditions. Failed endodontic procedures should be mentioned. All referrals to specialists in oral surgery, pedodontics, endodontics, periodontics, prosthodontics, oral pathology, oral medicine, oral Radiology and orthodontics should be mentioned. Hospital/Clinic/Associate/Affiliate shall be doing all such referrals only after having written consent by the Company with respect to any such referral to a particular specialist. Optional treatment or upgraded treatment should be discussed with the Client and approved by him accordingly. The Client should be made aware of all costs and all future visits in choosing one type of treatment over another. Consent and signature of the Client for the choice of treatment should be documented in his/her file.
23. Professional Liability Insurance. Hospital/Clinic/Associate/Affiliate, at its sole cost and expense, shall maintain throughout the term of this Agreement and for a period of four years following termination of this Agreement, a professional liability insurance i.e., medical mal-practice insurance covering adequate amount with respect to any claim or claims that may arise out of, or as a result of any alleged malpractice, negligence, acts or omissions caused or alleged to have been caused by the Hospital/Clinic/Associate/Affiliate, the dentists associated with him, his staff, agents or employees in the performance of, or omission of, any duty assumed by them hereunder or in connection herewith. The Hospital/Clinic/Associate/Affiliate, at its sole cost and expense, shall also maintain throughout the term of this Agreement, adequate worker compensation insurance as required and general liability insurance, including but not limited to premises, personal injury and contractual liability insurance.
24. Marketing of Plans. The Company will make reasonable efforts to market the Plans. The Hospital/Clinic/Associate/Affiliate agrees that the Company, in its discretion, may use the Hospital/Clinic/Associate/Affiliate information which may include but not be limited to name, address, contact number and specialties of the Hospital/Clinic/Associate/Affiliate in Plan marketing and informational materials including, without limitation, Plan directory of Participating Dentists. Nothing in this Agreement shall be deemed to require the Company to conduct any specific marketing activities on behalf of the Hospital/Clinic/Associate/Affiliate or to identify the Hospital/Clinic/Associate/Affiliate in any specific marketing or informational materials. It is only the Company which shall be responsible for enrollment of Clients in any Plan at its sole discretion and the Hospital/Clinic/Associate/Affiliate shall not interfere in the said matter and the Hospital/Clinic/Associate/Affiliate shall be providing his services to fulfill commitments made by the Company to any of its Clients.
25. Termination with cause. In case of a material breach of the Agreement by a Party, the other Party shall give the defaulting party a notice of said breach by registered post to the addresses as mentioned above while categorically mentioning the intent to terminate. After receiving the notice of termination, the defaulting Party will have 15 days to cure the breach. In the event, the defaulting Party fails to cure the breach within the period of 15 days, the other Party shall have the right to terminate the Agreement.
26. Termination without cause. In the event, the Hospital/Clinic/Associate/Affiliate is intending to terminate the Agreement for any reason apart from material breach of the Agreement, he shall give a notice of minimum three (3) months in writing and in the said event, the Company shall withhold the said three months' fee to ensure that the Hospital/Clinic/Associate/Affiliate gives quality care to the Clients. The said fee will be paid at the end of three months or thereafter. In the event of termination of this Agreement under this clause, the Hospital/Clinic/Associate/Affiliate shall continue to provide Services to the Clients of the Company who had approached the Hospital/Clinic/Associate/Affiliate prior to termination of the Agreement, as per the terms and conditions of the Agreement.
27. Indemnity. Hospital/Clinic/Associate/Affiliate shall indemnify and keep the Company, its officers, employees, managers, agents, successors and assigns ("Indemnitees") forever harmless against and from all liability, demands, claims, losses, damages and expenses, including actual attorneys' fees, sustained or incurred by Indemnitees, as a result of or arising out of Hospital/Clinic/Associate/Affiliate's or his associate dentists': (a) performance of the Services, (b) material breach of any portion of this Agreement, or (c) violation of any applicable law. All claims or losses arising out of any of the acts of the Hospital/Clinic/Associate/Affiliate or his associate dentists, other than claims for benefits shall be sole responsibility of the Hospital/Clinic/Associate/Affiliate only. The Company shall defend, indemnify and hold harmless the Hospital/Clinic/Associate/Affiliate and its directors, officers, employees, affiliates and agents against any claim, loss, damage, cost, expense or liability arising out of or related to the performance or non-performance by the Company, its employees or agents of any services to be performed by the Company under this Agreement.
28. Notices. Any notice or other communication under this Agreement shall be sent by personal delivery or by registered mail to the Parties at their respective addresses stated above.
29. Jurisdiction, Governing Law and Dispute Resolution. This Agreement will be governed by and construed in accordance with the laws of India. All disputes arising out of or in connection with this Agreement shall be resolved firstly, by discussions between the Parties. In case the discussions fail, the dispute will be resolved under the Arbitration and Conciliation Act, 1996 by a sole arbitrator appointed by the Company. The arbitration proceedings will be conducted in Jaipur. The seat of arbitration will be Jaipur. The language of the arbitration shall be in English. The courts in Jaipur shall have the exclusive jurisdiction.
30. Confidential Information. The Hospital/Clinic/Associate/Affiliate shall maintain confidential all information provided to it by the Company while performing under this Agreement including the eligibility list and any other information containing the names, addresses and telephone numbers of the Clients of the Company , lists or documents compiled by the Company which include the names, addresses, technical data, trade secrets, or know-how of the Parties, including, but not limited to, research and product plans, products, services, developments, inventions, processes, formulas, technology, marketing, finances or other business information, telephone numbers of employees and employers, any manual or any Plan or any financial arrangements between the Company and the Hospital/Clinic/Associate/Affiliate, disclosed to the receiving Party by disclosing party, either directly or indirectly, in writing, orally or otherwise ("Confidential Information"). Hospital/Clinic/Associate/Affiliate shall not disclose or use any of the Confidential Information for his/her own benefit or gain either during the term of this Agreement or after the date of termination of this Agreement.
31. Waiver. That any waiver by either party to this Agreement of a breach or violation of any provision of this Agreement shall not operate as or be construed to be a waiver of any subsequent breach or violation thereof.
32. Registration. The Company and Hospital/Clinic/Associate/Affiliate both shall bear equally the expenses of registration of the Agreement.
33. The provider needs to take measures to protected health information (PHI) of their patients’ records. The security, privacy and confidentiality of health information is essential requirement when using MDP Systems and workflows.

HENCE both the parties hereto now hereby set and subscribe their respective hands and seals on this HOSPITAL/CLINIC/ASSOCIATE/AFFILIATE AGREEMENT AGREEMENT on this day, month and the year as mentioned.

This document is computer generated and does not require signature or the stamp in order to be considered valid