9.1 COVERED DENTAL EXPENSES
An active Participant or dependent of an active Participant may go to any licensed dentist. Covered Dental Expenses are deemed to be incurred on the date dental care is received. Covered Dental Expenses are services that meet all of the following requirements:
- Services are rendered by a licensed dentist, licensed dental hygienist working under the supervision of a dentist, or Physician, whose charges are Usual, Customary and Reasonable as determined by the Plan.
- Services demonstrate Dental Necessity for treatment of a Participant’s dental condition. “Dental Necessity” means that a service or supply meets all of the following conditions:
- The treatment is appropriate given the symptoms, and is consistent with the diagnosis. “Appropriate” means that the type, level, length of service, and setting are needed to provide safe and adequate care;
- It is rendered in accordance with generally accepted practice and professionally recognized standards;
- It is not treatment that is regarded as Experimental and/or Investigational, educational, or unproven;
- It is specifically allowed by the licensing statutes which apply to the provider who renders the service; and
- It is not primarily for the convenience of the Participant, the Participant’s dentist, or another provider.
- Services are not specifically excluded from coverage.