COVERED DENTAL SERVICES. See Section 3 for additional benefit limits and coverage information. Network Dentists Non-network Dentists Crowns & Onlays* Under age 19 75% - After deductible 75% - After deductible Age 19 and older Not Covered Not Covered Oral surgery services* Under age 19 75% - After deductible 75% - After deductible Age 19 and older 40% - After 12 month waiting period 40% - After 12 month waiting period General anesthesia or IV sedation – in a dental office* Under age 19 75% - After deductible 75% - After deductible Age 19 and older 40% - After 12 month waiting period 40% - After 12 month waiting period Surgical periodontal services* Under age 19 75% - After deductible 75% - After deductible Age 19 and older Not Covered Not Covered Bridges and dentures* Under age 19 75% - After deductible 75% - After deductible Age 19 and older Not Covered Not Covered Implants Under age 19 75% - After deductible 75% - After deductible Age 19 and older - Coverage is for single tooth implant only; all other implants are not covered. Not Covered Not Covered Occlusal (night) guards* Under age 19 50% 50% Age 19 and older 50% 50% Under age 19 50% - After deductible 50% - After deductible Age 19 and older Not Covered Not Covered
COVERED DENTAL SERVICES. This section describes covered dental services. This plan covers services only if they meet all of the following requirements: • listed as a covered dental service in this section. The fact that a dentist has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered dental service under this plan. • dentally necessary services or medically necessary orthodontics, consistent with our dental policies and related guidelines at the time the services are provided. • not listed in Exclusions section. • received while a member is enrolled in the plan. • consistent with applicable state or federal law. We review dental necessity in accordance with our dental policies and related guidelines. Our dental policies can be found on our website. This plan only covers dental services that are dentally necessary or orthodontics which we determine are medically necessary. To help ensure that you and your dentist understand your benefits before the service is rendered, we recommend that you obtain a predetermination. A predetermination will provide your dentist with a coverage estimate for the services requested. We recommend that you or your dentist request a predetermination for the covered dental services in the Summary of Benefits marked with a (*). This plan does not apply pre-existing condition exclusions.
COVERED DENTAL SERVICES. See Section 3 for additional benefit limits and coverage information. Network Dentists Non-network Dentists
COVERED DENTAL SERVICES. We cover the following services when rendered by a dentist (See Section 8.0 - Glossary for definition of dentist). All covered dental services are subject to the provisions below. This agreement covers multi-stage procedures which have a start date before the effective date of this agreement if: • the multi-stage procedures have a completion date after the effective date of this • the multi-stage procedures are covered dental services under this agreement. Subject to any calendar year or other maximums, we will pay up to our allowance less any benefits paid or payable under any previous plan for multi-stage procedures.
COVERED DENTAL SERVICES. Pediatric dental benefits will be provided through the Dental Plan for Members up to the end of the Calendar Year in which the Member turns age 19 in accordance with the Maryland Children’s Health Insurance Plan dental benefits, which includes benefits for periodic screening in accordance with the periodicity schedule developed by the American Academy of Pediatric Dentistry and as specified in the Schedule of Benefits.
COVERED DENTAL SERVICES. Subject to the Exclusions, Limitations, and conditions of the Plan, a Covered Person is entitled to Benefits for the following Covered Services in the amounts specified in the Schedule of Benefits.
COVERED DENTAL SERVICES. The Benefits of this section are subject to all the terms and conditions of your Contract. Benefits are available only for services and supplies that are determined by the Plan to be “Medically Necessary”, unless otherwise specified. All Covered Services listed in this section are subject to the Exclusions and Limitations section of this Contract, which lists services, supplies, situations or related expenses that are not covered. It is important for you to refer to your Schedule of Benefits to find out what your Deductible, Coinsurance and Benefit Period Maximum will be for a Covered Service. If you do not have a Schedule of Benefits, please call a Customer Service Representative at the number shown on your Identification Card.
COVERED DENTAL SERVICES. See Section 3 for additional benefit limits and coverage information. Network Dentists Non-network Dentists Oral evaluations Under age 19 0% 0% Age 19 and older 0% 0% Cleanings (prophylaxis) Under age 19 0% 0% Age 19 and older 0% 0% X-rays Under age 19 0% 0% Age 19 and older 0% 0% Fluoride treatments Under age 19 0% 0% Age 19 and older Not Covered Not Covered Sealants Under age 19 0% 0% Age 19 and older Not Covered Not Covered Denture repairs, relines, and rebasing Under age 19 50% - After deductible 50% - After deductible Age 19 and older 20% - After deductible 20% - After deductible Space maintainers Under age 19 0% 0% Age 19 and older Not Covered Not Covered Palliative treatment Under age 19 20% 20% Age 19 and older 0% 0% Fillings Under age 19 50% - After deductible 50% - After deductible Age 19 and older 20% - After deductible 20% - After deductible Recementations Under age 19 50% - After deductible 50% - After deductible Age 19 and older 20% - After deductible 20% - After deductible Simple extractions Under age 19 50% - After deductible 50% - After deductible Age 19 and older 20% - After deductible 20% - After deductible Therapeutic Pulpotomies* Under age 19 50% - After deductible 50% - After deductible Age 19 and older 20% - After deductible 20% - After deductible Biopsies* Under age 19 50% - After deductible 50% - After deductible Age 19 and older 20% - After deductible 20% - After deductible Root canal therapy* Under age 19 50% - After deductible 50% - After deductible Age 19 and older 20% - After deductible 20% - After deductible Non-surgical periodontal services and Periodontal Maintenance* Under age 19 50% - After deductible 50% - After deductible Age 19 and older 20% - After deductible 20% - After deductible Crowns & Onlays* Under age 19 50% - After deductible 50% - After deductible Age 19 and older 50% - After deductible 50% - After deductible
COVERED DENTAL SERVICES. Charges up to the Benefit Maximum for: first installation, including adjustments of partial, permanent or full temporary or permanent removable dentures to replace or more natural teeth extracted while the person is insured; denture adjustments that occur more than 3 months after installation; replacement of an existing partial or full removable dentures, if it; was installed at least 5 years before and cannot be made serviceable; or is a temporary full denture which replaces one or more natural teeth extracted while the person is insured and for which replacement by a permanent denture is required and takes place within one year from the date the temporary denture was installed; and addition of teeth to an existing partial denture, if required to replace one or more natural teeth extracted while the person is insured.
COVERED DENTAL SERVICES. Subject to the limitations and exclusions included in this Contract, the Completed dental Services are Benefits when provided by a Provider (or other person legally permitted to perform such Services by authority of license) and are determined under the standards of generally accepted dental practice to be Necessary and appropriate. Benefits will be determined based on the terms of this Contract and Delta Dental’s Processing Policies.
