Common use of Implant Services Clause in Contracts

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. 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.