Medically Necessary Orthodontic Services definition

Medically Necessary Orthodontic Services means Enrollees must have a severe, dysfunctional, handicapping malocclusion. In order to qualify as medically necessary, a minimum score of 25 points using Salzmann Index criteria is required. Handicapping esthetic diagnoses (crooked, crowded or protruding teeth) due to appearance are not considered part of the determination. This Benefit does not apply to Adult Enrollees.
Sample 1Sample 2Sample 3
Medically Necessary Orthodontic Services means procedures that help to 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. Orthodontic services are not covered if the individual does not meet the criteria described above.
Sample 1Sample 2
Medically Necessary Orthodontic Services means Comprehensive Orthodontic Treatment that meets the criteria for “Dental Necessity” as defined in this policy and also meets at least one of the following criteria:
Sample 1Sample 2

Examples of Medically Necessary Orthodontic Services in a sentence

  • Dental services for treatment of congenital or developmental malformation, or services performed for cosmetic purposes, including but not limited to bleaching teeth, lack of tooth enamel and grafts to improve aesthetics, except as described in the Pediatric Medically Necessary Orthodontic Services section of PEDIATRIC DENTAL CARE BENEFITS.

  • There is no maximum benefit for Medically Necessary Orthodontic Services is not subject to limitation; however, the deductible will apply.

  • Medically Necessary Orthodontic Services provided to an Adult Enrollee.

  • When the relevant changes to these Terms and Conditions, BBMSL are material and will affect especially settlement or other monetary factors, BBMSL will give reasonable time to inform Merchants in writing.

  • Medically Necessary Orthodontic Services You are not covered for medically necessary orthodontic services unless approved by Delta Dental.

  • Contract Benefit Levels & Enrollee Coinsurances Dental Service Category PPO1 Dental Plan2 Enrollee2 Diagnostic and Preventive Services 100% 0% Basic Services 50% 50% Major Services 50% 50% Medically Necessary Orthodontic Services (requires prior authorization) 50% 50% Waiting Periods No Waiting Periods 1 Reimbursement is based on PPO Contracted Fees for PPO, Premier and Non-Delta Dental Providers.

  • Medically Necessary Orthodontic Services for individuals under 19 are not subject to this lifetime maximum.

  • The deductible period starts when your policy starts and continues through the end of the Benefit Accumulation Period.Orthodontic BenefitsThis Policy does not provide an orthodontic Benefit except for the Medically Necessary Orthodontic Services Benefit only for Covered Persons under the age of 19.

  • Medically Necessary Orthodontic Services: Dentally necessary orthodontia is covered for the treatment of congenital or hereditary conditions which result in craniofacial abnormalities which would require medically necessary surgical correction (as determined by the plan) due to problems related to swallowing, chewing, speaking, breathing, OR for acute injury to the teeth from an external force which cannot be stabilized by any other method.

  • Tubin, PhDLustick Consulting Narberth, PA, USA ilustick@lustickconsulting.com ABSTRACTThe original DOD objective which the process of Verification, Validation, and Accreditation exists to serve was to evaluate the credibility of models and simulations.

Related to Medically Necessary Orthodontic Services

  • Medically Necessary Services means those covered services that are, under the terms and conditions of the contract, determined through contractor utilization management to be:

  • Medically necessary care means care that is (1) appropriate and consistent with and essential for the prevention, diagnosis, or treatment of a Patient’s condition; (2) the most appropriate supply or level of service for the Patient’s condition that can be provided safely; (3) not provided primarily

  • Medically Necessary means a service which is appropriate and consistent with the treatment of the condition in accordance with accepted standards of community practice.

  • Home health aide services means the personal care and maintenance activities provided to individuals for the purpose of promoting normal standards of health and hygiene.

  • Orthodontic means a type of specialist dental treatment carried out by an orthodontist that diagnoses, prevents and corrects mispositioned teeth and jaws and misaligned bite patterns.

  • Genetic services means a genetic test, genetic counseling (including obtaining, interpreting, or assessing genetic information), or genetic education.

  • Medical physicist means a person trained in evaluating the performance of mammography equipment and facility quality assurance programs and who meets the qualifications for a medical physicist set forth in 41.6(3)“c.”

  • Diagnostic Services means services provided for the purpose of determining the nature and cause of a condition, ill- ness, or injury.

  • Mental health services provider means an individual, licensed or unlicensed, who performs or purports to perform mental health services, including a:

  • Medically fragile means the condition of a child who requires the availability of twenty-four-hour skilled care from a health care professional or specially trained staff or volunteers in a group care setting. These conditions may be present all the time or frequently occurring. If the technology, support and services being received by the medically fragile children are interrupted or denied, the child may, without immediate health care intervention, experience death.

  • Pharmacy services means the practice of pharmacy as defined in chapter 18.64 RCW and includes any drugs or devices as defined in chapter 18.64 RCW.

  • Outpatient services means those services rendered in a practitioner’s office or in the department of an approved facility where services are rendered to persons who have not had an overnight stay and are not charged for room and board.

  • Community mental health program means all mental health

  • Pharmacist services means products, goods, and services, or any combination of products, goods, and services, provided as a part of the practice of pharmacy.

  • Emergency medical technician means a person who is either an EMT-I, EMT-II, or EMT-P (paramedic), and possesses a valid certificate or license in accordance with the standards of Division 2.5 (commencing with Section 1797) of the Health and Safety Code.

  • Medical home means a team approach to providing health care that originates in a primary care setting; fosters a partnership among the patient, the personal provider, and other health care professionals, and where appropriate, the patient’s family; utilizes the partnership to access and integrate all medical and nonmedical health-related services across all elements of the health care system and the patient’s community as needed by the patient and the patient’s family to achieve maximum health potential; maintains a centralized, comprehensive record of all health-related services to promote continuity of care; and has all of the characteristics specified in section 135.158.

  • Medically Necessary Treatment means any treatment, tests, medication, or stay in hospital or part of a stay in hospital which:

  • Emergency Medical Technician (EMT means: an individual licensed with cognitive knowledge and a scope of practice that corresponds to that level in the National EMS Education Standards and National EMS Scope of Practice Model.

  • Medical Specialist means any medical practitioner who is vocationally registered by the Medical Council under the Health Practitioners Competence Assurance Act 2003 in one of the approved branches of medicine and who is employed in either that branch of medicine or in a similar capacity with minimal oversight.

  • Medical services means Medically Necessary services, including, as the context requires, Confinement, treatments, procedures, tests, examinations or other related services for the investigation or treatment of a Disability.

  • Mental health therapist means the same as that term is defined in Section 58-60-102.

  • Behavioral health services means mental health services as

  • Mental health services means interventions designed to provide the maximum reduction of mental disability and restoration or maintenance of functioning consistent with the requirements for learning, development and enhanced self-sufficiency. Services shall include:

  • Emergency medical services or “EMS” means an integrated medical care delivery system to provide emergency and nonemergency medical care at the scene or during out-of-hospital patient transportation in an ambulance.

  • Outpatient hospital services means preventive, diagnostic, therapeutic, observation, rehabilitation, or palliative services provided to an outpatient by or under the direction of a physician, dentist, or other practitioner by an institution that:

  • Emergency medical services personnel means that term as defined in section 20904 of the public health code, 1978 PA 368, MCL 333.20904.