Dental Policy disclaimer

The Dental Policy Manual is intended only for physicians and other health care professionals, except where otherwise indicated.

By clicking "I Accept" below, you acknowledge your understanding and agreement with the following:


Dental Policies have been developed through consideration of government approval status, dental necessity, generally accepted standards of dental practice, and review of dental literature.



Dental Policy is used as guidelines for coverage determinations in all health care insurance products, unless otherwise indicated.

Conflict with Other Documents

In the event of a conflict between a Dental Policy and any Plan document under which a member is entitled to Covered Services, the Plan document will govern. Plan documents include, but are not limited to, Subscriber Contracts, Summary Plan Documents, and other coverage documents prepared by a Plan.

Restrictions and Limitations

  • Dental Policies DO NOT determine the schedule of benefits. Rather, Dental Policies are used in the process to determine if a service will be paid by a Plan.
  • Dental Policies are interpreted and applied in the sole discretion of the Plan.
  • Dental Policy application is subject to state and federal laws and specific instructions from Plan Sponsors of self-insured groups.
  • Dental Policies DO NOT constitute dental advice and DO NOT guarantee any results or outcomes. If you are a member, you should discuss any related dental health care questions with your dental health care provider.
  • Dental Policies are the property of our healthcare plan and you are strictly prohibited from using them for any commercial use whatsoever. Commercial use does not include use of the Dental Policies for purposes related to the health care of a Plan member. In addition, Current Dental Terminology (CDT®) codes and descriptions are the property of the American Dental Association (ADA) with all rights reserved.
  • There is no obligation to update this site and the Dental Policies displayed may be out of date.

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