Emergency Dental Treatment Expense. When an Injury to whole and sound teeth is caused by a force or blow external to the mouth, and the Injury requires treatment, replacement or x-rays by a legally qualified dentist or oral surgeon, then the Insurer will pay the reasonable and necessary expenses incurred by the Insured Person. The total amount of payments made will not exceed the maximum as shown in the Schedule as a result of any one Accident. The following conditions apply:
Emergency Dental Treatment Expense. When, by reason of Injury to whole and sound teeth (capped or crowned teeth will, for the purposes of this policy, be considered whole and sound), due to a force or blow external to the mouth, requires treatment, replacement or x-rays by a legally qualified dentist or oral surgeon who does not ordinarily reside in the Insured Person’s Residence and is not an Immediate Family Member, within thirty (30) days from the date of the Injury, the Insurer will pay the reasonable and necessary expenses actually incurred by the Insured Person, subject to the maximum stated in the Schedule, as a result of any one (1) Accident. Any payments made under this section will be in accordance with the current Fee Guide for General Practitioners published by the Dental Association in the Insured Person's province of Residence. Alberta Only - any payments made under this section will be in accordance with the 1997 Alberta Fee Guide for General Practitioners plus an annual inflationary adjustment as determined by the Alberta Dental Association and the insurance industry and documented in the Insurance Industry Reimbursement Guide.
Emergency Dental Treatment Expense. Expenses for the repair or replacement of whole, functioning, sound, natural teeth where damage has resulted from a direct accidental injury which occurs while the employee is covered but not when caused by an object intentionally placed in the mouth. Prior to beginning treatment, details of the accident, relevant x-rays, pre-accident condition of the teeth, plan treatment and cost must be submitted to the Insurer. Approval of a treatment plan (except for emergency treatment required to alleviate pain) must be obtained from the Insurer prior to starting a course of treatment. These services must start within one hundred (100) days after the accident and be completed within twelve (12) months of the accident and must be the least expensive that will provide professionally adequate treatment. Coverage is limited to the fee stated in the current Provincial Dental Fee Schedule for a general practitioner in the province where the Insured Employee lives at the time that treatment is received. Expenses for the treatment of temporomandibular joint dysfunction (TMJ) or orthodontic services are not covered under this provision.
