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METLIFE DENTAL
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Last modified
3/27/2018 10:31:58 AM
Creation date
3/27/2018 9:36:51 AM
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Contracts
Company Name
METLIFE DENTAL
Contract #
A-2018-020
Agency
PERSONNEL SERVICES
Council Approval Date
2/6/2018
Destruction Year
0
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Emergency Dental Condition means a dental condition the onset of which is sudden, that manifests itself by <br />symptoms of sufficient severity, including, but not limited to, bleeding, swelling or severe pain, that a prudent <br />layperson, possessing an average knowledge of dentistry and health, could reasonably expect the absence of <br />Immediate dental attention to result in: <br />• placing the health of the person afflicted with such condition in serious jeopardy; <br />• serious Impairment to such person's bodily functions; <br />• serious impairment or dysfunction of any bodily organ or part of such person; or <br />• serious disfigurement of such person. <br />Endodontics means procedures that treat the nerve or the pulp of the tooth. These procedures are usually <br />needed due to injury or Infection of the tooth, <br />Experimental means services that do not have endorsement from professional organizations whose role is to <br />evaluate such Items. Services that are either unproven for the diagnosis or treatment of a condition or not <br />generally recognized by the professional community as effective or appropriate for the diagnosis or treatment <br />of a condition. <br />Maximum Allowed Charge means the lesser of: <br />• the amount charged by the Selected General Dentist or; <br />the maximum amount which the Selected General Dentist has agreed with Us to accept as <br />payment in full for the dental service. <br />Member means an Individual enrolled in the Safeguard dental plan, <br />Oral Surgery means surgery performed in and around the mouth, to remove teeth, reshape portions of the <br />bone or soft tissue, or biopsy suspect areas of the mouth. <br />Organization means an employer or other entity that has contracted with Us to arrange for the provision of <br />dental care benefits. <br />Orthodontics means braces and other procedures or appliances to help align the upper and lower teeth. <br />Out -of -Network Dentist means a Dentist who does not have a contractual agreement with Us to provide <br />Covered Services to You or a dependent <br />Periodontics means procedures related to treatment of the supporting structures of the teeth, such as gums <br />and underlying bone. <br />Posterior means teeth that have flat chewing surfaces, located in the back of the mouth - upper and lower <br />twenty (20) teeth, including molars, bicuspids (premolars), and wisdom teeth. <br />Prepayment Fee means the monthly fee paid to Us by Your Organization. The prepayment fee is not the <br />same as a Co -Payment. <br />Primary Teeth means the first set of teeth ("baby" teeth). <br />Prophylaxis means a standard cleaning, the scaling and polishing of teeth to remove plaque and tarter <br />above the gum fine. <br />Prosthodontics means the replacement of missing teeth with artificial substitutes. The appliances can be <br />fixed (bridge or implant) or removable (dentures). <br />Quadrant means one of the four equal sections into which Your mouth can be divided. <br />OCERT2011-DHMO-EOC zsC-ss 21 <br />
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