Dental Implants

Benefits are provided for services and supplies provided by an oral surgeon or physician for dental implants. Services and supplies are covered at 50 percent with a lifetime maximum of $1,000. If expenses exceed this $1,000 lifetime maximum, this plan will not pay the additional costs. These expenses are not subject to the $200 annual deductible or $2,300 annual coinsurance maximum.

For the purpose of this plan, dental implants refer to a device(s) inserted into or onto the maxilla (upper jaw bone) or mandible (lower jaw bone) to retain or support a dental prosthesis. A dental implant is considered acceptable treatment when clear clinical evidence shows a conventional fixed or removable prosthesis cannot provide clinically acceptable treatment. If dental implant treatment is elected when a conventional fixed or removable prosthesis provides acceptable clinical treatment, an allowance for the implant will be provided based on the appropriate amount in the Dental Fee Schedule, paid at 50 percent.

Covered services and supplies include:

• Hospital services and supplies and the administration of general anesthesia.
• The placement, repair or removal of endosseous, transosseous or subperiosteal implants, including connectors.
• Temporary appliances placed during the "no load" healing period (after implants are surgically placed and prior to the permanent superstructure) when performed in conjunction with implants.
• Alveolar ridge augmentation by surgical placement of osseous bone grafts and/or guided tissue regeneration, and/or vestibuloplasty when performed in conjunction with implants.

Limitations and Exclusions

Benefits are not provided for:

1. Tooth transplantation or implantation.
2. Permanent prosthetics (i.e., crowns, bridges, partials, or dentures) placed in conjunction with implants, except as provided for under "Scheduled Dental Benefits" on pages 97-104.
3. Services started before the patient was eligible under this plan or services rendered after termination of eligibility.
4. Services or supplies subject to the "General Limitations and Exclusions" on pages 163-170.