Dental Care a. Dental Care for Members over age 19 is limited to the following:
i. care and stabilization treatment rendered within 62 days of an Accidental Dental Injury provided such services are for the treatment of damage to Sound Natural Teeth;
ii. extraction of teeth required prior to radiation therapy when you have a diagnosis of cancer of the head or neck.
b. General anesthesia and hospitalization services are covered when required to assure the safe delivery of necessary dental treatment or surgery for a dental Condition which, if left untreated, is likely to result in a medical Condition if:
i. a Member has one or more medical Conditions that would create significant or undue medical risk for the Member in the course of delivery of any necessary dental treatment or surgery if not rendered in a Hospital or Ambulatory Surgery Center; or
ii. a Covered Dependent child is under eight years of age and it is determined by a licensed dentist and the Covered Dependent’s Attending Physician that dental treatment or surgery in a Hospital or Ambulatory Surgery Center is necessary due to a significantly complex dental Condition, or a developmental disability in which patient management in the dental office has proven to be ineffective.
Dental Care. Dental care is provided to you according to need and appropriateness, as determined by the LIFE health team. The first priority of your dental care is to treat pain and acute infections. The second priority is to maintain oral functioning, such as enabling you to chew your food as well as your health and oral conditions permit. Dental services may include: ♦ Diagnostic services - examinations, radiographs. ♦ Preventive services - prophylaxis, oral hygiene instructions. ♦ Restorative dentistry - fillings, temporary or permanent crowns. ♦ Prosthetic appliances - complete or partial dentures. ♦ Oral surgery - extractions, removal/modification of soft and hard tissue. ♦ Services for hearing and speech impairments. ♦ Language translation services. ♦ Other services determined necessary by the LIFE health team to improve and maintain your overall health status. ♦ Cosmetic surgery, unless required for improved functioning of a malformed part of the body resulting from an accidental injury or for reconstruction after mastectomy. ♦ Experimental, medical, surgical, or other health procedures not generally available in the area unless authorized by the LIFE health team. ♦ Any service rendered outside of the United States.
Dental Care. This plan does not cover dental services except as stated in Covered Services. This plan does not cover the following: Over-the-counter drugs, solutions, supplies, vitamins, food, or nutritional supplements, except as required by law Herbal, naturopathic, or homeopathic medicines or devices This plan does not cover therapy to provide a changed or controlled environment.
Dental Care. This agreement provides coverage for covered dental care services listed in this section. If a dental service is not specifically listed as covered, it is not covered under this agreement. Only services that we have reviewed and determined are eligible for coverage under this agreement are covered; all other services are not covered. See the Summary of Medical Benefits for benefit limits and the amount you pay. The following definitions apply to this Section 3.5:
Dental Care a. Dental Care is limited to the following:
i. care and stabilization treatment rendered within 90 days of an Accidental Dental Injury provided such services are for the treatment of damage to Sound Natural Teeth;
ii. extraction of teeth required prior to radiation therapy when you have a diagnosis of cancer of the head or neck.
b. General anesthesia and hospitalization services are covered when required to assure the safe delivery of necessary dental treatment or surgery for a dental Condition which, if left untreated, is likely to result in a medical Condition if:
i. a Member has one or more medical Conditions that would create significant or undue medical risk for the Member in the course of delivery of any necessary dental treatment or surgery if not rendered in a Hospital or Ambulatory Surgery Center; or
ii. a Covered Dependent child is under eight years of age and it is determined by a licensed dentist and the Covered Dependent’s Attending Physician that dental treatment or surgery in a Hospital or Ambulatory Surgery Center is necessary due to a significantly complex dental Condition, or a developmental disability in which patient management in the dental office has proven to be ineffective.
Dental Care. The County will continue to offer the Delta Dental and County Dental plans currently in effect.
Dental Care. Except as covered under section 4.B, the Plan does not provide Benefits for dental services, including but not limited to dental surgery, dental implants, or Orthognathic Surgery. Treatment of congenitally missing, malpositioned, or super numary teeth, even if part of a congenital anomaly is not covered except as stated in the Covered Services section or as required by law. Dental implants for treatment of oral cancer are not covered. Fluoride carriers are not covered by the Plan.
Dental Care a. For those members of the bargaining unit who are not covered by other dental insurance, the Board agrees to provide a plan composed of Class I – Preventative (office visits, cleaning, x-rays and fluoride): 100%, Class II – Restorative (crowns, fillings, root canals, periodontics, and oral surgery): 90%, class III – Major (bridges and dentures): 90%, Class IV – Orthodontic: 90% ($2000.00 lifetime maximum to age 19). Class I, II and III benefits will have a $2000.00 yearly maximum. This plan is a preferred provider organization (PPO) with no deductible when the employee utilizes the ADN, Dentemax or Michigan Dental Plan networks. Out-of-network services will be paid at the highest in-network rate among the three networks listed above. The employee will be responsible for any additional charges.
b. For those members of the bargaining unit who are covered by other dental insurance (including District - provided coverage), the Board agrees to provide a plan composed of Class I – Preventative (office visits, cleaning, x-rays and fluoride): 50%, Class II – Restorative (crowns, fillings, root canals, periodontics, and oral surgery): 50%, Class III – Major (bridges and dentures): 50%, Class IV – Orthodontic: 90% ($2000.00 lifetime maximum to age 19). Class I, II and III benefits will have $2000 yearly maximum. This plan is a preferred provider organization (PPO), with no deductible when the employee utilizes the ADN, Dentemax or Michigan Dental Plan Networks. Out-of- network services will be paid at the highest in-network rate among the three networks listed above; the employee will be responsible for any additional charges.
c. It is understood that the determination of the carrier or decision to self-insure is the right of the Board.
Dental Care. Provider shall ensure that dentists and non-dentist ----------- dental care personnel are available in sufficient numbers as are necessary or appropriate to provide Dental Care to reasonably meet the demand for such Dental Care. In the event that dentists employed by, or shareholders of, Provider are not available to provide Dental Care coverage, Provider shall engage and retain dentists on a temporary coverage basis, which dentists shall meet or exceed the qualifications required for Provider's Dental Care Professionals under this agreement. All costs and expenses associated with the retention of such temporary coverage shall be Provider Expenses. With the assistance of the Service Company, Provider and the dentists shall be responsible for scheduling dentist and non- dentist dental care personnel coverage of all dental procedures. Provider shall cause all dentists to exert their best efforts to develop and promote Provider in such a manner as to ensure Provider is able to serve the diverse needs of the community. Provider shall organize and maintain a high quality, cost-effective process for ensuring that patients will have timely access to emergency Dental Care on a 24-hour, seven day per week basis.
Dental Care. The College shall provide dental care insurance. The specifications and carrier shall be determined by the College. Coverage cannot be less than provided in June of 2006 (MESSA Delta Dental $1,000 per person total per benefit year on Class I, II and III 80/80/60); 50% co-pay up to $1,000 per person lifetime orthodontic maximum on class IV. These funds shall be limited to one plan per household.
