- A panoramic film with or without other films is considered equivalent to a full mouth series for coverage purposes. Coverage for multiple radiographs on the same date of service will not exceed the coverage level for complete mouth series.
- Charges for replacement of filling restorations are only covered once in a 24 month period, unless the damage to that tooth was caused by accidental injury not related to the normal function of the tooth or teeth.
- Endodontic (root canal treatment) on the same tooth is covered only once in a 2 year period. Re-treatment of the same tooth is allowed when performed by a different dental office.
- If an existing bridge or denture cannot be made satisfactory, a replacement will be covered only once in 7 years.
- Dental benefits for an initial or replacement crown, jacket, labial veneer, inlay or onlay on or for a particular tooth will only be provided once in 7 years, unless the damage to that tooth was caused by accidental injury not related to the normal function of the tooth or teeth.
- Initial placement of full or partial removable dentures, fixed bridges (including crowns and inlays which form a part thereof) to replace a tooth or teeth which were missing prior to the effective date of the individual’s coverage will not be covered unless the prosthetic appliance also includes replacement of a natural tooth or teeth extracted while coverage was in effect.
- A 12 month waiting period applies to all Coverage C services. Participants coming onto the plan after 1/1/2024 must be enrolled for 12 months in this plan before becoming eligible for Coverage C benefits, unless they can provide a certificate of creditable coverage and a benefit summary from their prior carrier proving coverage for major services for a full 12 months prior to coming onto the MCHCP plan.
- If you receive care from more than one dentist or service provider for the same procedure, benefits will not exceed what would have been paid to one dentist for that procedure (including, but not limited to prosthetics] root canal therapy).
- If alternative treatments are available, DDMO will be liable for the least costly professionally satisfactory treatment. This would include, but is not limited to services such as fixed bridges, in which case the benefits may be based on the allowed amount for a removable partial denture.
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