Orthopedic Appliances. Orthognathic (jaw) surgery for the treatment of TMJ disorders, radiology services and TMJ specialist services, including fitting/adjustment of splints are subject to the benefit limit set forth in the Allowances Schedule. Excluded are the following: orthognathic (jaw) surgery in the absence of a TMJ or severe obstructive sleep apnea diagnosis except for congenital anomalies, treatment for cosmetic purposes, dental services, including orthodontic therapy and any hospitalizations related to these exclusions.
Appears in 5 contracts
Samples: Medical Coverage Agreement, Medical Coverage Agreement, Group Medical Coverage Agreement
Orthopedic Appliances. Orthognathic (jaw) surgery for the treatment of TMJ disorders, radiology services and TMJ specialist services, including fitting/adjustment of splints are subject to the benefit limit set forth in the Allowances Schedule. Excluded are the following, regardless of origin or cause: orthognathic (jaw) surgery in the absence of a TMJ or severe obstructive sleep apnea diagnosis except for newborn infants with congenital anomalies, treatment for cosmetic purposes, dental services, including orthodontic therapy and any hospitalizations related to these exclusions.
Appears in 3 contracts
Samples: Group Medical Coverage Agreement, Group Medical Coverage Agreement, Group Medical Coverage Agreement
Orthopedic Appliances. Orthognathic (jaw) surgery for the treatment of TMJ disorders, radiology services and TMJ specialist services, including fitting/adjustment of splints are subject to the benefit limit set forth in the Allowances Schedule. Excluded are the followingExcluded: treatment for cosmetic purposes, bite blocks, dental services including orthodontic therapy, or any orthognathic (jaw) surgery in the absence of a TMJ or diagnosis of TMJ, severe obstructive sleep apnea diagnosis except for or congenital anomalies, treatment for cosmetic purposes, dental services, including orthodontic therapy and any anomaly. Any hospitalizations related to these exclusionsexclusions is also excluded.
Appears in 2 contracts
Samples: Group Health Cooperative Medical Coverage Agreement, Group Health Cooperative Medical Coverage Agreement