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Reso 2001-399
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Reso 2001-399
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Last modified
6/11/2013 4:45:14 PM
Creation date
1/25/2006 1:56:58 PM
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CityClerk-Resolutions
Resolution Type
Resolution
Resolution Number
2001-399
Date (mm/dd/yyyy)
12/13/2001
Description
– Bid 01-10-01: Jefferson Pilot Life Ins&Eye Med: Emp Dental Vision etc.
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<br />(12) the retreatment or adjustment, recementation, reline, rebase, replacement or repair of cast restorations, crowns and <br />prostheses, when made by the same Dentist or dental office which provided the initial service, within 6 months of <br />the completion of the service, <br /> <br />(13) the replacement of: <br />(a) any full or partial denture, within fIve years; or <br />(b) fIXed prosthetic (crown, inlay or onlay restoration, or fIxed bridge) within eight years; <br />of the date of the last placement of these items, If a replacement is required because of an accidental dental injury <br />sustained while the Covered Person is covered under this Policy, it will be a Covered Expense. (Damage <br />resulting from biting food or other objects is not considered to be an accidental injury.) <br /> <br />(14) the insertion, maintenance or removal of implants, and any related expenses. <br /> <br />(15) specialized procedures, including: <br />(a) precision or semi-precision attachments; <br />(b) precious metals for removable appliances; <br />(c) overlays and overdentures; or <br />(d) personalization or characterization, <br /> <br />(16) duplicate prosthetics, or for initial placement or replacement of athletic mouth guards, bruxism appliances or any <br />appliance to correct harmful habits; and for replacement of: <br />(a) space maintainers; or <br />(b) misplaced, lost or stolen dental appliances, <br /> <br />(17) appliances, restorations or procedures, or their modifIcations, that: <br />(a) alter vertical dimension; <br />(b) restore or maintain occlusion or for occlusal adjustment or equilibration; or <br />(c) splint teeth or replace tooth structure lost as a result of erosion, abfraction, abrasion or attrition, <br /> <br />(18) charges for services provided by: <br />(a) an ambulatory surgical facility; <br />(b) a hospital; <br />(c) any other facility; or <br />(d) an anesthesiologist. <br /> <br />(19) analgesia, sedation, hypnosis or acupuncture, for anxiety or apprehension. <br /> <br />(20) any medications administered outside the dentist's office or for prescription drugs. <br /> <br />(21) charges which do not directly provide treatment for a dental injury or condition, such as: <br />(a) the completion of claim forms; <br />(b) broken appointments; <br />(c) interest or collection charges; <br />(d) sales or other taxes or surcharges; <br />(e) education, training and supplies used for dietary or nutritional counseling, personal oral hygiene <br />or dental plaque control; <br />(f) caries susceptibility tests, bacteriologic studies, histopathologic exams or pulp vitality testing; or <br />(g) duplication ofx-.rays or other dental records. <br /> <br />GLll-16B-EX FL <br /> <br />21 <br /> <br />Has TMJ, (I-ill) <br />09/01/01 <br />
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