Oral Surgery. Benefits for oral surgery include root recovery, surgical exposure of impacted or unerupted teeth, fractures and dislocations of the face or jaw, surgical excisions (e.g., cysts, tori, exostosis), dental implants for the treatment of oral cancer and cancer of the esophagus, and lingual frenulum repairs under certain conditions. Orthognathic surgery is limited to conditions resulting in significant functional impairment, or for the treatment of congenital birth defects in newborns, as required by law. Anesthesia charges associated with oral surgery are covered for Member’s who are seven (7) years of age or younger and Members who are developmentally disabled when determined by Keystone to be Medically Necessary and when a successful result cannot be expected for treatment under local anesthesia and for whom a superior result can be expected under general anesthesia. Anesthesia and all related benefits for Members seven (7) years of age or younger and Members who are developmentally disabled are subject to all applicable cost-sharing amounts.
Appears in 4 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
