Accidental Dental Injury Services. We cover restorative Services necessary to promptly repair, but not replace, Sound Natural Teeth that have been injured as the result of an external force. Coverage is provided when all of the following conditions have been met: • The accident has been reported to your primary care Plan Physician within 72 hours of the accident. • A Plan Provider provides the restorative dental Services. • The injury occurred as the result of an external force. “External force” is defined as violent contact with an external object; not force incurred while chewing. • The injury was sustained to Sound Natural Teeth. • The covered Services must be requested within 60 days of the injury. • The covered Services are provided during the 12 consecutive month period commencing from the date that the injury occurred. Coverage under this benefit is provided for the most cost-effective procedure available that, in the opinion of the Plan Provider, would produce the most satisfactory result. For the purposes of this benefit, Sound Natural Teeth are defined as a tooth or teeth that (a) have not been weakened by existing dental pathology such as decay or periodontal disease, or (b) have not been previously restored by a crown, inlay, onlay, porcelain restoration, or treatment by endodontics. Accidental Dental Injury Services Exclusions: • Services provided by non-Plan Providers. • Services provided after 12 months from the date the injury occurred. • Services for teeth that have been avulsed (knocked out) or that have been so severely damaged that in the opinion of the Plan Provider, restoration is impossible.
Accidental Dental Injury Services. We cover restorative Services necessary to promptly repair, but not replace, sound natural teeth that have been injured as the result of an external force. Coverage is provided when all of the following conditions have been satisfied:
