Common use of Medically Necessary Hospitalization for Dental Care Clause in Contracts

Medically Necessary Hospitalization for Dental Care. PIC covers hospitalization for dental care. This is limited to charges incurred by a member who: (1) is a child under age 5; (2) is severely disabled; or (3) has a medical condition unrelated to the dental procedure that requires hospitalization or anesthesia for dental treatment. Coverage is limited to facility and anesthesia charges. Oral surgeon/dentist or dental specialist professional fees are not covered for dental services provided, except as described in item 2 above. The following are examples, though not all-inclusive, of medical conditions that may require hospitalization for dental services: severe asthma, severe airway obstruction or hemophilia. Care must be directed by a physician or by a dentist or dental specialist.