View attachment 17584
Here's the now defunct UPS Administered National PT Health Plan. Implants are explicitly listed under "what's not covered;" the exception is unless it's specifically approved in advance. The problem is that the verbiage favors UPS -- "not covered" and absolutely no definition of what would make it approved in advance. UPS told me that implants would be approved ONLY when medically necessary, as I noted above. There are oodles of examples of people having doctors sign off their claim as medically necessary and UPS rejecting it for various reasons.
Your co-worker got lucky, but this is no change to benefits.
Don't know what plan you were in. I see the exclusion for dental implants in your summary unless medically necessary. Here are the exclusions in the plan that I was in. Nothing about dental implants. Trust me, implants were covered in my old plan. They are not in Teamcare.
What is Not Covered Under
Dental Options 1 and 2
In addition to services not specifically
listed in
Covered Expenses above, the
following expenses are not covered
by the dental options:
• Remineralization (Calcium Hydroxide,
temporary restoration) as a separate procedure
only
• Occlusal adjustment (unless following
periodontal surgery) or retainers if charged
separately from orthodontic treatment
• Claims received more than 12 months
past the date of service
• IV sedation, except in certain circumstances;
call Aetna at 1-800-UPS-1508
• Appliances, restoration or procedures
needed to alter vertical dimensions or
restore occlusion or for the purpose of
splinting or correcting non-severe attrition
or abrasion
• Dentures and bridgework when they are
for the replacement of teeth that were
extracted before the patient was covered
by a UPS-administered dental plan
• Orthodontic treatment begun before covered
by a UPS-administered dental plan
• Root canal therapy, if the pulp chamber
was opened before the patient was covered
by a UPS dental option
• Relines and adjustments of dentures and
partial dentures within six months after
installation
• Cosmetic dental services and supplies,
including personalization or characterization
of dentures
• Prosthetic devices and appliances, including
bridges and crowns, and expenses
for fitting or modifying them, if installed
or delivered more than 30 days after the
patient’s coverage ends
• Replacement of lost, stolen or broken
appliances
• Replacement of congenitally missing teeth
• Education programs, such as plaque control
or oral hygiene instruction
• A charge for a replacement or modifi -
cation of a partial or fully removable
denture, a removable bridge or fi xed
bridgework, or for adding teeth to any
of these, or for a replacement or modifi -
cation of an inlay, onlay, crown or cast
processed restoration, within fi ve years
after installation
• Localized delivery of antimicrobial
agents; such as Actisite®, Atridox®,
Arestin® and PerioChip®
• Local anesthesia or nitrous oxide,
as a separate charge
• Any prescription drug
• Full mouth debridement
• Guided tissue regeneration
• Desensitization treatment
• Precision attachments except as noted
under
Major Services in this section
• Infection control
• Behavior management
• Canal preparation, if submitted as
a separate charge
• Rubber dam
• Services not required for the treatment of
a specific condition or to maintain good
dental hygiene, as determined by Aetna
• Services not reasonably necessary or
customarily performed, as determined in
keeping with guidelines adopted by Aetna
• Services not furnished by a licensed
dentist, except services provided by a
licensed hygienist under the direction of
a dentist or X-rays ordered by a dentist
• Services covered by the medical options
• Charges for a missed or broken
appointment
• Charges for the dentist’s travel