Dental Clinical Policies & Coverage Guidelines

Please read the terms and conditions below carefully.

UnitedHealthcare has developed Dental Clinical Policies and Dental Coverage Guidelines to assist us in administering dental plan benefits. These policies and guidelines are provided for informational purposes and do not constitute clinical advice. Treating dentists and other health care providers are solely responsible for determining what care to provide to their patients. Members should always consult their dentist or physician before making any decisions about dental or medical care.

Our Dental Clinical Policies express our determination of whether a dental service (e.g. procedure or technology) is proven to be effective based on the published clinical evidence. They are also used to decide whether a given dental service is clinically necessary.  Services determined to be experimental, investigational, unproven, or not clinically necessary by the clinical evidence are typically not covered.

Dental Coverage Guidelines are used to determine whether a service falls within a benefit category or is excluded from coverage. Dental Coverage Guidelines may also address such matters as periodicity and other limitations, including whether a procedure is cosmetic, based on evidence.

Benefit coverage for dental services is determined by the member specific benefit plan document, such as a Certificate of Coverage, Schedule of Benefits, or Summary Plan Description, and applicable laws that may require coverage for a specific service. The member specific benefit plan document identifies which services are covered, which are excluded, and which are subject to limitations. In the event of a conflict, the member specific benefit plan document supersedes these policies and guidelines.

Dental Clinical Policies and Dental Coverage Guidelines are developed as needed, are regularly reviewed and updated, and are subject to change. They represent a portion of the resources used to support UnitedHealthcare coverage decision making. The information presented in these policies and guidelines is believed to be accurate and current as of the date of publication, and is provided on an "AS IS" basis. Additionally, UnitedHealthcare may use tools developed by third parties including the American Dental Association and other peer organizations to assist us in administering dental benefits. These third-party  guidelines are intended to be used in connection with the independent professional clinical judgment of a qualified  dentist or other health care provider and do not constitute the practice of dentistry or dental advice.

Dental Clinical Policies and Dental Coverage Guidelines are the property of UnitedHealthcare. Unauthorized copying, use and distribution of this information are strictly prohibited. Third party guidelines are proprietary to the originating organization and are not published on this website.

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