Orthognathic Surgery. (surgery to reposition the upper and/or lower jaw) which is Medically Necessary to cor- rect a skeletal deformity; or 7. Dental and orthodontic services that are an integral part of Reconstructive Surgery for cleft palate repair. No benefits are provided for: 1. Services performed on the teeth, gums (other than for tumors and dental and orthodontic services that are an in- tegral part of Reconstructive Surgery for cleft palate re- pair) and associated, periodontal structures, routine care of teeth and gums, diagnostic Services, preventive or periodontic Services, dental orthoses and prostheses, in- cluding hospitalization incident thereto; 2. Orthodontia (dental services to correct irregularities or malocclusion of the teeth) for any reason (except for or- thodontic services that are an integral part of Reconstruc- tive Surgery for cleft palate repair), including treatment to alleviate TMJ; 3. Dental implants (endosteal, subperiosteal or transosteal); 4. Any procedure (e.g. vestibuloplasty) intended to prepare the mouth for dentures or for the more comfortable use of dentures; 5. Alveolar ridge surgery to the jaws if performed primarily to treat disease related to the teeth, gums or periodontal structures, or to support natural or prosthetic teeth; or 6. Fluoride treatments except when used with radiation therapy to the oral cavity. See Principal Limitations, Exceptions, Exclusions, and Re- ductions, General Exclusions for additional Services that are not covered.
Appears in 3 contracts
Samples: Health Service Agreement, Evidence of Coverage and Health Service Agreement, Health Service Agreement
Orthognathic Surgery. (surgery to reposition the upper and/or lower jaw) which is Medically Necessary to cor- rect a skeletal deformity; or
7. Dental and orthodontic services that are an integral part of Reconstructive Surgery for cleft palate repair. No benefits are provided for:
1. Services performed on the teeth, gums (other than for tumors and dental and orthodontic services that are an in- tegral part of Reconstructive Surgery for cleft palate re- pair) and associated, associated periodontal structures, routine care of teeth and gums, diagnostic Services, preventive or periodontic Services, dental orthoses and prostheses, in- cluding hospitalization incident thereto;
2. Orthodontia (dental services to correct irregularities or malocclusion of the teeth) for any reason (except for or- thodontic services that are an integral part of Reconstruc- tive Surgery for cleft palate repair), including treatment to alleviate TMJ;
3. Dental implants (endosteal, subperiosteal or transosteal);
4. Any procedure (e.g. vestibuloplasty) intended to prepare the mouth for dentures or for the more comfortable use of dentures;
5. Alveolar ridge surgery to of the jaws if performed primarily to treat disease diseases related to the teeth, gums or periodontal structures, structures or to support natural or prosthetic teeth; or
6. Fluoride treatments except when used with radiation therapy to the oral cavity. See Principal Limitations, Exceptions, Exclusions, Exclusions and Re- ductions, General Exclusions for additional Services that are not covered.
Appears in 2 contracts
Orthognathic Surgery. (surgery to reposition the upper and/or lower jaw) which is Medically Necessary to cor- rect a skeletal deformity; or
7. Dental and orthodontic services that are an integral part of Reconstructive Surgery for cleft palate repair. No benefits are provided for:
1. Services performed on the teeth, gums (other than for tumors and dental and orthodontic services that are an in- tegral part of Reconstructive Surgery for cleft palate re- pair) and associated, associated periodontal structures, routine care of teeth and gums, diagnostic Services, preventive or periodontic Services, or dental orthoses and prostheses, in- cluding including hospitalization incident thereto;
2. Orthodontia (dental services to correct irregularities or malocclusion of the teeth) for any reason (except for or- thodontic services that are an integral part of Reconstruc- tive Surgery for cleft palate repair), including treatment to alleviate TMJ;
3. Dental implants (endosteal, subperiosteal or transosteal);
4. Any procedure (e.g. vestibuloplasty) intended to prepare the mouth for dentures or for the more comfortable use of dentures;
5. Alveolar ridge surgery to of the jaws if performed primarily to treat disease diseases related to the teeth, gums or periodontal structures, or to support natural or prosthetic teeth; or;
6. Fluoride treatments except when used with radiation therapy to the oral cavity. See Principal Limitations, Exceptions, Exclusions, Exclusions and Re- ductions, General Exclusions for additional Services that are not covered.
Appears in 2 contracts
Orthognathic Surgery. (surgery to reposition the upper and/or lower jaw) which is Medically Necessary to cor- rect a skeletal deformity; or
7. Dental and orthodontic services that are an integral part of Reconstructive Surgery for cleft palate repair. No benefits are provided for:
1. Services performed on the teeth, gums (other than for tumors and dental and orthodontic services that are an in- tegral part of Reconstructive Surgery for cleft palate re- pair) and associated, associated periodontal structures, routine care of teeth and gums, diagnostic Services, preventive or periodontic Services, dental orthoses and prostheses, in- cluding hospitalization incident thereto;
2. Orthodontia (dental services to correct irregularities or malocclusion of the teeth) for any reason (except for or- thodontic services that are an integral part of Reconstruc- tive Surgery for cleft palate repair), including treatment to alleviate TMJ;
3. Dental implants (endosteal, subperiosteal or transosteal);
4. Any procedure (e.g. vestibuloplasty) intended to prepare the mouth for dentures or for the more comfortable use of dentures;
5. Alveolar ridge surgery to of the jaws if performed primarily to treat disease diseases related to the teeth, gums or periodontal structures, structures or to support natural or prosthetic teeth; or;
6. Fluoride treatments except when used with radiation therapy to the oral cavity. See Principal Limitations, Exceptions, Exclusions, Exclusions and Re- ductions, General Exclusions for additional Services that are not covered.
Appears in 1 contract
Samples: Health Service Agreement