Traditional Orthodontic Services. If shown as included in the Schedule of Dental Benefits, Traditional Orthodontic Services will be covered for Members under age 19. This Benefit will be subject to the Traditional Orthodontic Services Lifetime Maximum specified in the Schedule of Dental Benefits. Authorization is required for coverage. An explanation of the plan of treatment must be submitted to UCD. Upon review of the information, UCD will notify You and Your dentist of the reimbursement schedule, frequency of payment over the course of the treatment, and Your share of the cost. 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.
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Samples: Limited Benefit Contract, Limited Benefit Contract, Limited Benefit Contract