Common use of COVERED DENTAL SERVICES Clause in Contracts

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. 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.