Dental Insurance

Emergency Dental Care means dental screening, examination, and evaluation by a dentist, or, to the extent permitted by applicable law, by appropriate personnel under the supervision of a dentist to determine if an Emergency Dental Condition exists, and, if it does, the care and treatment necessary to relieve or eliminate the Emergency Dental Condition.

All selected General Dental Offices provide treatment for Emergency Dental Conditions twenty-four (24) hours a day, seven (7) days a week, and We encourage the Member to seek care from the selected General Dental Office. If treatment for an Emergency Dental Condition is required, the Member may go to any dental provider, go to the closest emergency room, or call 911 for assistance, as necessary. Prior authorization is not required.

The reimbursement from Us for treatment for an Emergency Dental Condition, if any, is limited to the extent the treatment the Member received directly relates to the evaluation and stabilization of the Emergency Dental Condition. All reimbursements will be allocated in accordance with the group contract, subject to any exclusions and limitations. Hospital charges and/or other charges for care received at any hospital or outpatient care facility are not Covered Services.

If the Member receives treatment for an Emergency Dental Condition, the Member will be required to pay the charges to the dentist and submit a claim to SafeGuard for a benefits determination. If the Member seeks treatment for an Emergency Dental Condition from a provider located more than 50 miles away from the selected General Dentist, the Member will receive coverage for the treatment of the Emergency Dental Condition up to a maximum of $50.

To be reimbursed for treatment of an Emergency Dental Condition, the Member must notify Us after receiving such treatment. If the Member’s physical condition does not permit such notification, the Member must make the notification as soon as it is reasonably possible to do so. Please include your name, ID number, address and telephone number on all requests for reimbursement.

All SafeGuard Selected General Dental Offices and Specialty Care Dentists provide emergency dental services twenty-four (24) hours a day, seven (7) days a week. In the event of a dental emergency, simply contact Your Selected General Dentist who will make arrangements for emergency dental care, including the treatment and stabilization of an Emergency Dental Condition.

If You cannot reach Your Selected General Dentist or SafeGuard’s Customer Service., you may obtain emergency dental services from any Dentist. SafeGuard will provide coverage for the following emergency dental services without regard to whether the Dentist or provider furnishing the services has a contractual or other arrangement to provide services to covered individuals:

• Dental screening examinations and other evaluations required by state or federal law, which are necessary to determine whether an Emergency Dental Condition exists.

• Necessary emergency dental care services, including the treatment and stabilization of an Emergency Dental Condition.

• Services originating in a dental office following treatment or stabilization of an Emergency Dental Condition, providing a prudent layperson possessing an average knowledge of medicine and health has made inquiry to and received authorization from SafeGuard for the post stabilization services. SafeGuard shall respond to the treating Dentist within the time appropriate to the circumstances relating to the delivery of the services and the condition of the Member, but in no case to exceed one (1) hour.

Examples of dental emergency treatment include procedures. administered in a Dentist’s office, dental clinic, or other comparable facility, to evaluate and stabilize dental conditions of a recent onset and severity accompanied by excessive bleeding, severe pain, or acute infection that would lead a prudent layperson to believe that immediate care is needed.

If medically necessary covered dental services are not available through a Selected General Dentist or Specialty Care Dentist, SafeGuard will, within the time appropriate to the circumstances relating to the delivery of the services and the condition of the patient, but in no event more than five (5) business days after receipt of reasonably requested documentation, allow a referral to an Out-of-Network Dentist and shall fully reimburse the Out-of-Network Dentist at the Reasonable and Customary Charge or an agreed upon rate.