Orthodontic Services Clause Samples
The Orthodontic Services clause defines the scope and terms under which orthodontic treatments are provided under an agreement. It typically outlines which specific orthodontic procedures are covered, such as braces or aligners, and may specify any limitations, exclusions, or requirements for pre-authorization. This clause ensures that both parties understand what orthodontic care is included, thereby preventing misunderstandings and clarifying the extent of coverage or service obligations.
Orthodontic Services. This plan covers medically necessary orthodontics and related services for members under age nineteen (19).
Orthodontic Services. Minor treatment for tooth guidance; Minor treatment to control harmful habits; Interceptive orthodontic treatment; Comprehensive orthodontic treatment; Treatment of an atypical or extended skeletal case; Post-treatment stabilization; Separate lifetime maximum of $1,500 per each enrollee; Orthodontic services for dependents up to age 19; for enrolled employee and spouse, no maximum age. Orthodontic coverage shall be extended to each dependent up to age 25 if the dependent is a full-time student at an accredited institution.
Orthodontic Services. 50% of the cost of braces and other treatments required to straighten teeth for dependent children, up to a separate lifetime maximum of $4000.00 for each child. Note that for this benefit ortho work must have been started by the time the eligible dependent has reached the age of 19.
Orthodontic Services. The necessary treatment and procedures required for the correction of malposed teeth.
Orthodontic Services. Effective January 1, 2000, subject to fifty percent (50%) co-insurance with a lifetime maximum benefit of $1,800 per insured. Effective June 1, 2001, subject to fifty percent (50%) co-insurance with a lifetime maximum benefit of $2,000 per insured. Effective January 1, 2002, subject to fifty percent (50%) co-insurance with a lifetime maximum benefit of $2,250 per insured. Effective January 1, 2003, subject to fifty percent (50%) co-insurance with a lifetime maximum benefit of $2,500 per insured.
Orthodontic Services. A. Benefits for orthodontic services will only be available until the end of the calendar year in which the Member turns age 19 if the Member:
1. Has fully erupted permanent teeth with at least 1/2 to 3/4 of the clinical crown being exposed (unless the tooth is impacted or congenitally missing); and
2. Has a severe, dysfunctional, handicapping malocclusion and is determined to be Medically Necessary.
B. All comprehensive orthodontic services require a pre-treatment estimate (PTE) by CareFirst, as described in the Estimate of Eligible Benefits section. The following documentation must be submitted with the request for a PTE:
1. ADA 2006 or newer claim form with service code requested;
2. A complete series of intra-oral photographs;
3. Diagnostic study models (trimmed) with waxbites or OrthoCad electronic equivalent, and
4. Treatment plan including anticipated duration of active treatment.
C. Covered benefits if a PTE is approved
Orthodontic Services. Effective May 1, 2007, 50% co- insurance to a maximum of $3,000 per person per lifetime.
Orthodontic Services. 50% of the cost of braces and other treatments required to straighten teeth for dependent children, up to a separate lifetime maximum of $3000 for eligible dependent children (up to the age of 18). Private duty nursing subject to $10,000 maximum per illness. Out of province emergency treatment subject to $1,000,000 per person lifetime maximum.
Orthodontic Services. Services, treatment, and procedures to correct malposed teeth (for example, braces).
Orthodontic Services. Effective April 1, 2003, subject to fifty per cent (50%) co-insurance with a lifetime maximum benefit of twenty-five hundred dollars ($2,500) per insured.
(f) Employees will be eligible for items (a), (b), (c), (d), and (e) after three (3) consecutive months of service.