Medically Necessary Orthodontics Sample Clauses

Medically Necessary Orthodontics. Orthodontic services will only be covered under this Section if the Member fits the following criteria: Members must have a fully erupted set of permanent teeth to be eligible for comprehensive orthodontic services. All orthodontic services require Authorization, a written plan of care, and must be rendered by a Provider. Orthodontic treatment must be considered medically necessary and be the only method considered capable of: Preventing irreversible damage to the member’s teeth or their supporting structures. Restoring the member’s oral structure to health and function.
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Medically Necessary Orthodontics. Covered Benefits include services for limited, interceptive and comprehensive Orthodontic treatment of the primary, transitional and adolescent dentition in addition to removable and fixed appliance therapy. Treatment visits are provided for pre-orthodontic, periodic orthodontic and orthodontic retention. Members must have a fully erupted set of permanent teeth to be eligible for comprehensive orthodontic services. Orthodontic treatment must be considered medically necessary and be the only method considered capable of: Preventing irreversible damage to the member’s teeth or their supporting structures. Restoring the member’s oral structure to health and function.
Medically Necessary Orthodontics. Orthodontic services will only be covered under this Section if the Member fits the following criteria: 1. Members must have a fully erupted set of permanent teeth to be eligible for comprehensive orthodontic services. 2. All orthodontic services require Authorization, a written plan of care, and must be rendered by a Provider. 3. Orthodontic treatment must be considered medically necessary and be the only method considered capable of: a. Preventing irreversible damage to the member’s teeth or their supporting structures. b. Restoring the member’s oral structure to health and function. 4. A medically necessary orthodontic service is an orthodontic procedure that occurs as a part of an approved orthodontic treatment plan that is intended to treat a severe dentofacial abnormality or serious handicapping malocclusion. Orthodontic services for cosmetic purposes are not covered. 5. Orthodontia procedures will only be approved for dentofacial abnormalities that severely compromise the member’s physical health or for serious handicapping malocclusions. Presence of a serious handicapping malocclusion is determined by the magnitude of the following variables: degree of malalignment, missing teeth, angle classification, overjet and overbite, open bite, and crossbite. 6. Dentofacial abnormalities that severely compromise the member’s physical health may be manifested by: a. Markedly protruding upper jaw and teeth, protruding lower jaw and teeth, or the protrusion of upper and lower teeth so that the lips cannot be brought together. b. Under-developed lower jaw and receding chin. c. Marked asymmetry of the lower face. 7. A “handicapping” malocclusion is a condition that constitutes a hazard to the maintenance of oral health and interferes with the well-being of the recipient by causing: a. Obvious difficulty in eating because of the malocclusion, so as to require a liquid or semisoft diet, cause pain in jaw joints during eating, or extreme grimacing or excessive motions of the orofacial muscles during eating because of necessary compensation for anatomic deviations. b. Obvious severe breathing difficulties related to the malocclusion, such as unusually long lower face with downward rotation of the mandible in which lips cannot be brought together, or chronic mouth breathing and postural abnormalities relating to breathing difficulties. c. Lisping or other speech articulation errors that are directly related to orofacial abnormalities and cannot be corrected by means o...
Medically Necessary Orthodontics. Covered Benefits include services for limited, interceptive and comprehensive Orthodontic treatment of the primary, transitional and adolescent dentition in addition to removable and fixed appliance therapy. Treatment visits are provided for pre-orthodontic, periodic orthodontic and orthodontic retention. Orthodontic services will only be covered under this Section if the Member fits the following criteria: Members must have a fully erupted set of permanent teeth to be eligible for comprehensive orthodontic services. Orthodontic treatment must be considered medically necessary and be the only method considered capable of: Preventing irreversible damage to the member’s teeth or their supporting structures. Restoring the member’s oral structure to health and function.
Medically Necessary Orthodontics. Covered Benefits include services for limited, interceptive and comprehensive Orthodontic treatment of the primary, transitional and adolescent dentition in addition to removable and fixed appliance therapy. Treatment visits are provided for pre-orthodontic, periodic orthodontic and orthodontic retention. 97176EX-039 R01/21 20 1.
Medically Necessary Orthodontics. Covered Benefits include services for limited, interceptive and comprehensive Orthodontic treatment of the primary, transitional and adolescent dentition in addition to removable and fixed appliance therapy. Treatment visits are provided for pre-orthodontic, periodic orthodontic and orthodontic retention. Orthodontic services will only be covered under this Section if the Member fits the following criteria: 1. Members must have a fully erupted set of permanent teeth to be eligible for comprehensive orthodontic services. 2. All orthodontic services require Authorization, a written plan of care, and must be rendered by a Provider. 3. Orthodontic treatment must be considered medically necessary and be the only method considered capable of: a. Preventing irreversible damage to the member’s teeth or their supporting structures.

Related to Medically Necessary Orthodontics

  • Medically Necessary In general, We will not Cover any dental service, procedure, treatment, test or device that We determine is not Medically Necessary. If an External Appeal Agent certified by the State overturns Our denial, however, We will Cover the service, procedure, treatment, test or device for which coverage has been denied, to the extent that such service, procedure, treatment, test or device, is otherwise Covered under the terms of this Contract.

  • Orthodontics We Cover orthodontics used to help restore oral structures to health and function and to treat serious medical conditions such as: cleft palate and cleft lip; maxillary/mandibular micrognathia (underdeveloped upper or lower jaw); extreme mandibular prognathism; severe asymmetry (craniofacial anomalies); ankylosis of the temporomandibular joint; and other significant skeletal dysplasias.

  • Prosthodontics We Cover prosthodontic services as follows:

  • Radiation Therapy/Chemotherapy Services This plan covers chemotherapy and radiation services. This plan covers respiratory therapy services. When respiratory services are provided in your home, as part of a home care program, durable medical equipment, supplies, and oxygen are covered as a durable medical equipment service.

  • Hospice Individuals whose permanent residence and principal work location are outside the State of Minnesota and outside of the service areas of the health plans participating in Advantage. If these individuals use the plan administrator’s national preferred provider organization in their area, services will be covered at Benefit Level Two. If a national preferred provider is not available in their area, services will be covered at Benefit Level Two through any other provider available in their area. If the national preferred provider organization is available but not used, benefits will be paid at the POS level described in paragraph “i” below. All terms and conditions outlined in the Summary of Benefits will apply.

  • Outpatient If you receive infusion therapy services in a hospital's outpatient unit, we cover the use of the treatment room, related supplies, and solutions. For prescription drug coverage, see Section 3.27

  • Non-Medical, Personalized Services The Practice shall also provide Members with the following non-medical services:

  • Volunteer Peer Assistants 1. Up to eight (8)

  • Dependent Care Assistance Program The County offers the option of enrolling in a Dependent Care Assistance Program (DCAP) designed to qualify for tax savings under Section 129 of the Internal Revenue Code, but such savings are not guaranteed. The program allows employees to set aside up to five thousand dollars ($5,000) of annual salary (before taxes) per calendar year to pay for eligible dependent care (child and elder care) expenses. Any unused balance is forfeited and cannot be recovered by the employee.

  • Physician Visits This plan covers the services of a physician or other provider in charge of your medical care while you are inpatient in a general or specialty hospital.

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