Questions & answers · Dental insurance
Is a predetermination required before a crown or root canal?
AI-drafted from filed documents · reviewed: pendingwhether a specific event is covered
Under ConnectiCare Insurance Company, Inc.'s filed form in Connecticut (CT), root canal treatment and crowns are not covered [1]. This does not appear in these excerpts — check the full policy.
Under Principal Life Insurance Company's filed form in Washington (WA), coverage for root canal therapy is provided only if the pulp chamber was opened and the pulp canal explored to the apex while the individual or dependent was insured [2]. Coverage for crowns is provided only if the tooth or teeth were fully prepared while the individual or dependent was insured [2]. This does not appear in these excerpts — check the full policy.
To determine if predetermination is required, review the full policy or contact Principal Life Insurance Company for Washington (WA) or ConnectiCare Insurance Company for Connecticut (CT).
Information only — not legal advice. The insurer decides.
These answers quote forms insurers filed with state regulators. Your own policy, its endorsements and your state’s rules control. A filed form may not be the version sold to you.
Where this comes from (2)
[1] ConnectiCare Insurance Company, Inc. · CT · SERFF CCIC-134547007 · p. 2 · 8 · Simple Extractions
Simple Extractions Not covered Major Services Limitations Surgical Extractions Not covered N/A N/A Endodontic Therapy (Root Canal Treatment) Not covered Periodontal Scaling and Root Planing Not covered Periodontal Maintenance Not covered Periodontal Therapy Not covered Crowns and Cast Restorations Not covered Prosthodontics (Complete and Partial Dentures; Fixed Bridgework) Not covered Other Services Limitations
[2] Principal Life Insurance Company · WA · SERFF PRLF-131352019 · form GH 1100 (PPO)-CBPI · p. 44 · 152 · EXTENDED BENEFITS - INDIVIDUAL TERMINATIONS
EXTENDED BENEFITS - INDIVIDUAL TERMINATIONS (after termination of insurance) If Dental Expense Insurance under the Group Policy ceases and if you or your Dependents qualify, We will pay for: - root canal therapy, but only if the pulp chamber was opened and the pulp canal explored to the apex while you or a Dependent were insured; and - crowns, bridges, inlays, or onlay restorations, but only if the tooth or teeth were fully prepared while you or a Dependent were insured; and - complete or partial dentures, but only if the master impression was made while you or a Dependent were insured; provided the Treatment or Service is received within 30 days after your insurance or a Dependent's insurance terminates. You or a Dependent will qualify if: - you or a Dependent would have qualified for benefit payment had insurance remained in force; and - the Treatment or Service began while you or a Dependent were insured; and - the Group Policy is in force at the time Treatment or Service is received. … (excerpt — the filed text continues)
Drafted by a local AI model from the excerpts above, then checked by rules (citations, no rankings, no “not covered” claims from a partial excerpt). Question id Q81e73721. Spotted an error? Tell us.