Common use of Dental Benefits Clause in Contracts

Dental Benefits. Subject to the applicable Deductible, Coinsurance or Copayments shown on the Schedule of Insurance and Premium rates, We cover the diagnostic, preventive, restorative, endodontic, periodontal, prosthodontic, oral and maxillofacial surgical, orthodontic and certain adjunctive services in the dental benefit package as described in this provision for Members through the end of the month in which the Member turns age 19 when services are provided by a [Network] provider. Dental services are available from birth with an age one dental visit encouraged. A second opinion is allowed. Emergency treatment is available without prior authorization. Emergency treatment includes, but may not be limited to treatment for: pain, acute or chronic infection, facial, oral or head and neck injury, laceration or trauma, facial, oral or head and neck swelling, extensive, abnormal bleeding, fractures of facial bones or dislocation of the mandible. Diagnostic and preventive services are linked to the provider, thus allowing a member to transfer to a different provider/practice and receive these services. The new provider is encouraged to request copies of diagnostic radiographs if recently provided. If they are not available radiographs needed to diagnose and treat will be allowed. Denials of services to the dentist shall include an explanation and identify the reviewer including their contact information. Services with a dental laboratory component that cannot be completed can be considered for prorated payment based on stage of completion. Unspecified services for which a specific procedure code does not exist can be considered with detailed documentation and diagnostic materials as needed by report. Services that are considered experimental in nature will not be considered. This Policy will not cover any charges for broken appointments.

Dental Benefits. Subject to the applicable Deductible, Coinsurance or Copayments shown on the Schedule of Insurance and Premium rates, We cover the diagnostic, preventive, restorative, endodontic, periodontal, prosthodontic, oral and maxillofacial surgical, orthodontic and certain adjunctive services in the dental benefit package as described in this provision for Members through the end of the month in which the Member turns age 19 when services are provided by a [Network] provider. • Dental services are available from birth with an age one dental visit encouraged. • A second opinion is allowed. • Emergency treatment is available without prior authorization. Emergency treatment includes, but may not be limited to treatment for: pain, acute or chronic infection, facial, oral or head and neck injury, laceration or trauma, facial, oral or head and neck swelling, extensive, abnormal bleeding, fractures of facial bones or dislocation of the mandible. • Diagnostic and preventive services are linked to the provider, thus allowing a member to transfer to a different provider/practice and receive these services. The new provider is encouraged to request copies of diagnostic radiographs if recently provided. If they are not available radiographs needed to diagnose and treat will be allowed. • Denials of services to the dentist shall include an explanation and identify the reviewer including their contact information. • Services with a dental laboratory component that cannot be completed can be considered for prorated payment based on stage of completion. • Unspecified services for which a specific procedure code does not exist can be considered with detailed documentation and diagnostic materials as needed by report. • Services that are considered experimental in nature will not be considered. • This Policy will not cover any charges for broken appointments.

Dental Benefits. Subject to the applicable Deductible, Coinsurance or Copayments shown on the Schedule of Insurance and Premium rates, We cover the diagnostic, preventive, restorative, endodontic, periodontal, prosthodontic, oral and maxillofacial surgical, orthodontic and certain adjunctive services in the dental benefit package as described in this provision for Members through the end age of the month in which the Member turns age 19 18 when services are provided by a [Network] provider. • Dental services are available from birth with an age one dental visit encouraged. • A second opinion is allowed. • Emergency treatment is available without prior authorization. Emergency treatment includes, but may not be limited to treatment for: pain, acute or chronic infection, facial, oral or head and neck injury, laceration or trauma, facial, oral or head and neck swelling, extensive, abnormal bleeding, fractures of facial bones or dislocation of the mandible. • Diagnostic and preventive services are linked to the provider, thus allowing a member to transfer to a different provider/practice and receive these services. The new provider is encouraged to request copies of diagnostic radiographs if recently provided. If they are not available radiographs needed to diagnose and treat will be allowed. • Denials of services to the dentist shall include an explanation and identify the reviewer including their contact information. • Services with a dental laboratory component that cannot be completed can be considered for prorated payment based on stage of completion. • Unspecified services for which a specific procedure code does not exist can be considered with detailed documentation and diagnostic materials as needed by report. • Services that are considered experimental in nature will not be considered. • This Policy will not cover any charges for broken appointments.

Dental Benefits. Subject to the applicable Deductibledeductible, Coinsurance or Copayments shown on the Schedule of Insurance and Premium rates, We cover the diagnostic, preventive, restorative, endodontic, periodontal, prosthodontic, oral and maxillofacial surgical, orthodontic and certain adjunctive services in the dental benefit package as described in this provision for Members through the end of the month in which the Member turns age 19 when services are provided by a [Network] Network provider.  Dental services are available from birth with an age one dental visit encouraged.  A second opinion is allowed.  Emergency treatment is available without prior authorization. Emergency treatment includes, but may not be limited to treatment for: pain, acute or chronic infection, facial, oral or head and neck injury, laceration or trauma, facial, oral or head and neck swelling, extensive, abnormal bleeding, fractures of facial bones or dislocation of the mandible.  Diagnostic and preventive services are linked to the provider, thus allowing a member to transfer to a different provider/practice and receive these services. The new provider is encouraged to request copies of diagnostic radiographs if recently provided. If they are not available available, radiographs needed to diagnose and treat will be allowed.  Denials of services to the dentist shall include an explanation and identify the reviewer including their contact information.  Services with a dental laboratory component that cannot be completed can be considered for prorated payment based on stage of completion.  Unspecified services for which a specific procedure code does not exist can be considered with detailed documentation and diagnostic materials as needed by report.  Services that are considered experimental in nature will not be considered.  This Policy will not cover any charges for broken appointments.

Dental Benefits. Subject to the applicable Deductible, Coinsurance or Copayments shown on the Schedule of Insurance and Premium rates, We cover the diagnostic, preventive, restorative, endodontic, periodontal, prosthodontic, oral and maxillofacial surgical, orthodontic and certain adjunctive services in the dental benefit package as described in this provision for Members through the end of the month in which the Member turns age 19 when services are provided by a [Network] provider. Dental services are available from birth with an age one dental visit encouraged. A second opinion is allowed. Emergency treatment is available without prior authorization. Emergency treatment includes, but may not be limited to treatment for: pain, acute or chronic infection, facial, oral or head and neck injury, laceration or trauma, facial, oral or head and neck swelling, extensive, abnormal bleeding, fractures of facial bones or dislocation of the mandible. Diagnostic and preventive services are linked to the provider, thus allowing a member to transfer to a different provider/practice and receive these services. The new provider is encouraged to request copies of diagnostic radiographs if recently provided. If they are not available radiographs needed to diagnose and treat will be allowed. Denials of services to the dentist shall include an explanation and identify the reviewer including their contact information. Services with a dental laboratory component that cannot be completed can be considered for prorated payment based on stage of completion. Unspecified services for which a specific procedure code does not exist can be considered with detailed documentation and diagnostic materials as needed by report. Services that are considered experimental in nature will not be considered. This Policy Contract will not cover any charges for broken appointments.

Dental Benefits. Subject to the applicable Deductible, Coinsurance or Copayments shown on the Schedule of Insurance and Premium rates, We cover the diagnostic, preventive, restorative, endodontic, periodontal, prosthodontic, oral and maxillofacial surgical, orthodontic and certain adjunctive services in the dental benefit package as described in this provision for Members through the end of the month in which the Member turns age 19 when services are provided by a [Network] provider. • Dental services are available from birth with an age one dental visit encouraged. • A second opinion is allowed. • Emergency treatment is available without prior authorization. Emergency treatment includes, but may not be limited to treatment for: pain, acute or chronic infection, facial, oral or head and neck injury, laceration or trauma, facial, oral or head and neck swelling, extensive, abnormal bleeding, fractures of facial bones or dislocation of the mandible. • Diagnostic and preventive services are linked to the provider, thus allowing a member to transfer to a different provider/practice and receive these services. The new provider is encouraged to request copies of diagnostic radiographs if recently provided. If they are not available radiographs needed to diagnose and treat will be allowed. • Denials of services to the dentist shall include an explanation and identify the reviewer including their contact information. • Services with a dental laboratory component that cannot be completed can be considered for prorated payment based on stage of completion. • Unspecified services for which a specific procedure code does not exist can be considered with detailed documentation and diagnostic materials as needed by report. • Services that are considered experimental in nature will not be considered. • This Policy Contract will not cover any charges for broken appointments.

Dental Benefits. Subject to the applicable Deductible, Coinsurance or Copayments shown on the Schedule of Insurance and Premium rates, We cover the diagnostic, preventive, restorative, endodontic, periodontal, prosthodontic, oral and maxillofacial surgical, orthodontic and certain adjunctive services in the dental benefit package as described in this provision for Members through the end age of the month in which the Member turns age 19 18 when services are provided by a [Network] provider.  Dental services are available from birth with an age one dental visit encouraged.  A second opinion is allowed.  Emergency treatment is available without prior authorization. Emergency treatment includes, but may not be limited to treatment for: pain, acute or chronic infection, facial, oral or head and neck injury, laceration or trauma, facial, oral or head and neck swelling, extensive, abnormal bleeding, fractures of facial bones or dislocation of the mandible.  Diagnostic and preventive services are linked to the provider, thus allowing a member to transfer to a different provider/practice and receive these services. The new provider is encouraged to request copies of diagnostic radiographs if recently provided. If they are not available radiographs needed to diagnose and treat will be allowed.  Denials of services to the dentist shall include an explanation and identify the reviewer including their contact information.  Services with a dental laboratory component that cannot be completed can be considered for prorated payment based on stage of completion.  Unspecified services for which a specific procedure code does not exist can be considered with detailed documentation and diagnostic materials as needed by report.  Services that are considered experimental in nature will not be considered.  This Policy will not cover any charges for broken appointments. Diagnostic Services * Indicated diagnostic services that can be considered every 3 months for individuals with special healthcare needs are denoted with an asterisk.

Dental Benefits. Subject to the applicable Deductibledeductible, Coinsurance or Copayments shown on the Schedule of Insurance and Premium rates, We cover the diagnostic, preventive, restorative, endodontic, periodontal, prosthodontic, oral and maxillofacial surgical, orthodontic and certain adjunctive services in the dental benefit package as described in this provision for Members through the end of the month in which the Member turns age 19 when services are provided by a [Network] Network provider. • Dental services are available from birth with an age one dental visit encouraged. • A second opinion is allowed. • Emergency treatment is available without prior authorization. Emergency treatment includes, but may not be limited to treatment for: pain, acute or chronic infection, facial, oral or head and neck injury, laceration or trauma, facial, oral or head and neck swelling, extensive, abnormal bleeding, fractures of facial bones or dislocation of the mandible. • Diagnostic and preventive services are linked to the provider, thus allowing a member to transfer to a different provider/practice and receive these services. The new provider is encouraged to request copies of diagnostic radiographs if recently provided. If they are not available available, radiographs needed to diagnose and treat will be allowed. • Denials of services to the dentist shall include an explanation and identify the reviewer including their contact information. • Services with a dental laboratory component that cannot be completed can be considered for prorated payment based on stage of completion. • Unspecified services for which a specific procedure code does not exist can be considered with detailed documentation and diagnostic materials as needed by report. • Services that are considered experimental in nature will not be considered. • This Policy will not cover any charges for broken appointments.