Common use of Dentist Clause in Contracts

Dentist. A professional practitioner who holds a lawful license issued by any state of the United States, or its territories, authorizing the person to practice dentistry and dental surgery in such state or territory, including, but not limited to, a Doctor of Dental Surgery (DDS) or a Doctor of Medical Dentistry (DMD). A Subscriber other than the Member as shown in the Eligibility section. A companion of the same sex or opposite sex with whom the Member has entered into a Domestic Partnership. A same-sex or opposite sex couple in a committed relationship, similar to a marriage, but without an official marriage license. The date when your coverage begins. A person entitled to apply to be a Member as specified in the Eligibility section. EXCHANGE (also known as “Health Insurance Marketplace”) A governmental agency or non-profit entity that meets the applicable Health Insurance Exchange standards, and other related standards established under the Affordable Care Act (“ACA”) and makes Qualified Health Plans (QHPs) and Exchange-Certified Dental Plans available to qualified individuals and qualified employers. Unless otherwise identified, the term Exchange refers to State Exchanges, regional Exchanges, subsidiary Exchanges and a Federally facilitated Exchange on which Blue Cross and Blue Shield of Oklahoma offers this Exchange-Certified Dental Plan. A dental plan that has in effect a certification that it meets the applicable standards issued or recognized by each Exchange through which such plan is offered. A drug, device, biological product, or dental treatment or procedure is Experimental, Investigational or Unproven if the Plan determines that: • The drug, device, biological product, or dental treatment or procedure cannot be lawfully marketed without approval of the appropriate governmental or regulatory agency and approval for marketing has not been given at the time the drug, device, biological product, or dental treatment or procedure is furnished; or • The drug, device, biological product, or dental treatment or procedure is the subject of ongoing phase I, II or III clinical trials or under study to determine its maximum tolerated dose, its toxicity, its safety, its efficacy, or its efficacy as compared with the standard means of treatment or diagnosis; or • The prevailing opinion among peer reviewed dental and scientific literature regarding the drug, device, biological product, or dental treatment or procedure is that further studies or clinical trials are necessary to determine its maximum tolerated dose, its toxicity, its safety, its efficacy or its efficacy as compared with a standard means of treatment or diagnosis. Approval by a governmental or regulatory agency will be taken into consideration by the Plan in assessing Experimental/Investigational/Unproven status of a drug, device, biological product, or medical treatment or procedure but will not be determinative. The card issued to the Member by the Plan, bearing the Member's name, identification number and group number. A specific procedure or supply provided to you that is reasonably required, in the judgment of the Plan, for the treatment or management of your specific dental symptom, injury, or condition and is the most efficient and economical procedure that can safely be provided to you. The fact that a Dentist or Physician may prescribe, order, recommend or approve a procedure does not make such a procedure Medically Necessary. To be Medically Necessary, the procedure or supply must also conform to approved and generally accepted standards of accepted dental practice prevailing in the state when and where the procedure or supply is ordered. Such procedures or supplies are also subject to review and analysis by dental consultants, retained by the Plan. These consultants review the claim and diagnostic materials submitted in support of the claim, and based upon their professional opinions, determine the necessity and propriety of treatment.