Osseointegrated implants are dental implants inserted in the lower jaw which serve as anchorage points for fixed dental bridges. They become permanently implanted as new bone growth forms around them. The procedure is typically performed in stages with stage 1 being the insertion of the implants, stage 2 includes the abutment connection and stage 3 completes the procedure by attaching the crowns or fixed dental bridge to the implants.
This policy does not apply to Federal Employee Program (FEP) members.
Osseointegrated implants may be eligible for benefits. Written prior approval is required.
The following criteria must be met before approval will be granted:
Request for implants when related to dental accident: If the service is related to a dental accident, benefits equal to that available under the dental accident provision of a member’s benefit plan can be applied toward the cost of the dental implants even if the above criteria is not met. After the dental allowance is applied toward the charges, any remaining amounts would then be the subscriber’s responsibility.
Example: The dental allowance of a 3-unit bridge would be available to apply toward the implant cost. Dental accident benefits would still be subject to the definitions, conditions, limitations and exclusions of the member’s Benefit Plan.
When determined to be medically appropriate and necessary benefits are available for stages 1 and 2 reconstruction (the insertion of the implants and the subsequent abutment connection).
Benefits are not available for stage 3 (the crowns or fixed dental bridge attached to the implants) unless due to major trauma or tumor resection.
Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information.