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Policy No:  67A

Originally Created: 01/01/1999

Section: Miscellaneous

Last Reviewed:  01/01/2019

Last Revised:  01/01/2019

Approved: 01/01/2019

Effective:  01/01/2019

 

Description

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.

Dental accident:
Injury to a sound natural tooth caused solely by unexpected, external, violent and accidental means.

* Injury during chewing and biting is not considered accidental.

Policy/criteria

Procedure is in accordance with generally accepted standards of dental practice.

Administrative guidelines

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.

Disclaimer

Your use of this Dental Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Dental Policy Disclaimer.