Policy No: 67A
Originally Created: 01/01/1999
Last Reviewed: 01/01/2019
Last Revised: 01/01/2019
Dental services provided for the repair and/or restoration of sound natural teeth as a result of injury by accident.
Sound natural tooth:
A tooth that is whole or properly restored (restoration with amalgams or resin-based composite fillings); is without impairment, periodontal, or other conditions; and is not in need of the treatment provided for any reason other than an accidental injury. A tooth previously restored with a crown, inlay, onlay, or porcelain restoration, or treated by endodontics, is not considered a sound natural tooth.
Injury to a sound natural tooth caused solely by unexpected, external, violent and accidental means.
Injury during chewing and biting is not considered accidental.
Procedure is in accordance with generally accepted standards of dental practice.
Process to contract benefits.
Treatment of injury to a sound dentition or fractured jaw if the treatment is given by a physician or dentist, must be diagnosed within six months of the date of the accident and the treatment is provided within twelve months of the date of the accident. The injury must be one that occurred while the person was enrolled under the contract.
Treatment time may be extended if treatment is prolonged due to post-surgical healing time.