Implant Services. Procedure provided by properly licensed Dentists for implant placement, implant supported prosthetics, and maintenance and repair of implants and implant supported prosthetics provided under this Plan.
Implant Services. Includes adjustments, if needed, for the first six months after placement, if the Enrollee continues to be eligible and the service is provided at the Contract Dentist’s facility where the implant was originally delivered. - Replacement of a retainer, pontic, or stress breaker requires the existing bridge to be 60+ months old. - FPD, as referenced below, stands for fixed partial denture. - Each retainer and each pontic constitutes a unit in a fixed partial denture (bridge). - Replacement of a crown, pontic, inlay, onlay or stress breaker requires the existing bridge to be 60+ months old. - Includes pre-operative and post-operative evaluations and treatment under a local anesthetic. - Orthodontic Services must meet medical necessity as determined by a Contract Dentist. Orthodontic treatment is a Benefit only when medically necessary as evidenced by a severe handicapping malocclusion and when prior Authorization is obtained. Severe handicapping malocclusion is not a cosmetic condition. Teeth must be severely misaligned causing functional problems that compromise oral and/or general health. - Pediatric Enrollee must continue to be eligible, benefits for medically necessary orthodontics will be provided in periodic payments to the Contract Dentist. - Comprehensive orthodontic treatment procedures (D8080, D8090) include all appliances, adjustments, insertion, removal and post treatment stabilization (retention). No additional charge to the Enrollee is permitted except for services provided by an orthodontist other than the original treating Contract Orthodontist or dental office. - Refer to Schedule B for Limitations and Exclusions for medically necessary orthodontics for additional information.
Implant Services. Surgical placement of an implant body, including healing cap, for enrollees age sixteen (16) and older.
Implant Services. The implant and the associated crown over the implant are a Benefit for persons sixteen (16) years of age and over, limited to once per tooth in an eighty−four (84) consecutive month period. Some implant procedures or procedures associated with implants are not covered services under the plan and no benefits will accrue or be payable for those excluded procedures.
Implant Services. Procedures for implant placement, implant−supported prosthetics, and maintenance and repair of implants and implant−supported prosthetics.
Implant Services. Includes adjustments, if needed, for the first six months after placement, if the Enrollee continues to be eligible and the service is provided at the Contract Dentist’s facility where the implant was originally delivered. - Replacement of a retainer, pontic, or stress breaker requires the existing bridge to be 60+ months old. - FPD, as referenced below, stands for fixed partial denture. - Each retainer and each pontic constitutes a unit in a fixed partial denture (bridge). - Replacement of a crown, pontic, inlay, onlay or stress breaker requires the existing bridge to be 60+ months old. - Includes pre-operative and post-operative evaluations and treatment under a local anesthetic. - Pediatric Enrollee must continue to be eligible, benefits for medically necessary orthodontics will be provided in periodic payments to the Contract Dentist. - Comprehensive orthodontic treatment procedures (D8080, D8090) include all appliances, adjustments, insertion, removal and post treatment stabilization (retention). No additional charge to the Enrollee is permitted except for services provided by an orthodontist other than the original treating Contract Orthodontist or dental office. - Refer to Schedule B for Limitations and Exclusions for medically necessary orthodontics for additional information.
Implant Services. Includes adjustments, if needed, for the first six months after placement, if the Enrollee continues to be eligible and the service is provided at the Contract Dentist’s facility where the implant was originally delivered. - Replacement of a retainer, pontic, or stress breaker requires the existing bridge to be 60+ months old. - FPD, as referenced below, stands for fixed partial denture. - Cost Share for Benefits in this category is subject to the Plan Deductible described in your <EOC NAME>. You pay the Charges shown below until you have met the Plan Deductible. After you meet the Plan Deductible, the Services are covered at no charge for the remainder of the year. - Each retainer and each pontic constitutes a unit in a fixed partial denture (bridge). - Replacement of a crown, pontic, inlay, onlay or stress breaker requires the existing bridge to be 60+ months old. - Cost Share for Benefits in this category is subject to the Plan Deductible described in your <EOC NAME>. You pay the Charges shown below until you have met the Plan Deductible. After you meet the Plan Deductible, the Services are covered at no charge for the remainder of the year. - Includes pre-operative and post-operative evaluations and treatment under a local anesthetic. - Cost Share for Benefits in this category is subject to the Plan Deductible described in your <EOC NAME>. You pay the Charges shown below until you have met the Plan Deductible. After you meet the Plan Deductible, the Services are covered at no charge for the remainder of the year. - Orthodontic Services must meet medical necessity as determined by a Contract Dentist. Orthodontic treatment is a Benefit only when medically necessary as evidenced by a severe handicapping malocclusion and when prior Authorization is obtained. Severe handicapping malocclusion is not a cosmetic condition. Teeth must be severely misaligned causing functional problems that compromise oral and/or general health. - Pediatric Enrollee must continue to be eligible, benefits for medically necessary orthodontics will be provided in periodic payments to the Contract Dentist. - Comprehensive orthodontic treatment procedures (D8080, D8090) include all appliances, adjustments, insertion, removal and post treatment stabilization (retention). No additional charge to the Enrollee is permitted except for services provided by an orthodontist other than the original treating Contract Orthodontist or dental office. - Cost Share for Benefits in this category is ...
Implant Services. Includes adjustments, if needed, for the first six months after placement, if the Enrollee continues to be eligible and the service is provided at the Contract Dentist’s facility where the implant was originally delivered. - Replacement of a retainer, pontic, or stress breaker requires the existing bridge to be 60+ months old. - FPD, as referenced below, stands for fixed partial denture. - Each retainer and each pontic constitutes a unit in a fixed partial denture (bridge). - Replacement of a crown, pontic, inlay, onlay or stress breaker requires the existing bridge to be 60+ months old. - Includes pre-operative and post-operative evaluations and treatment under a local anesthetic. - Refer to Schedule B for Limitations and Exclusions for medically necessary orthodontics for additional information.
Implant Services. Procedures for implant placement, implant-supported prosthetics, and maintenance and repair of implants and implant-supported prosthetics. Form No. 1000.3 2 of 13 CONFIDENTIAL Appendix B Revised January 2022
