Qualifying Conditions

QUALIFYING CRITERIA

You will be asked to demonstrate that you have read, understand and agree to the following criteria upon which Plan membership is granted and through which the Protect insurance policy is offered to the dental practice and subsequent insurance policies provided to Patients.

They should be read in conjunction with the Protect Policy Terms and Conditions.

GENERAL CRITERIA

  • The dental surgeon undertaking the procedure has received appropriate training including a mentor programme in the technique being performed.

  • Preparation and planning in line with accepted Dental protocol has been undertaken in respect of the planning and implementation of Patient treatment plans.

  • Implants have been placed and restored following accepted clinical and surgical protocols 

  • The patient gives consent to disclosure of their clinical notes to our claims department where necessary in the event of a claim

  • The patient's medical conditions are not compromised 

SPECIFIC CRITERIA

  • Evidence of a thorough Patient pre-assessment to assess suitability for treatment is mandatory 

  • Bespoke consent forms are signed by the Patient (in respect of Data Protection legislation and permission for the dentist to provide patient details where appropriate to the Insurer if required in the event of a claim)

  • In the event of a claim, evidence may be required to confirm that accepted industry protocols and procedures have been adopted and followed.

  • Bite guards are made for patients with a known history of bruxing or clenching

  • Restorations are fitted within a balanced occlusal scheme which should be maintained at all times.

  • All clinical work is undertaken in accordance with CQC (Care Quality Commission) standards

  • The cost of temporary restorations is excluded from cover

QUALIFYING PATIENTS

  • The patient must have completed a signed and dated up to date medical history form 

  • Absolute medical contraindications (where a Guarantee can not be offered to Patients) are:    

    • Patients on Bisphosphonates (IV)

    • History of radiation therapy to the jaws

    • Severe immunosuppression

  • Patients who have genetic / metabolic / systemic disorders which may affect bone physiology or healing should have a letter from their Physician or General Medical Practitioner stating they are suitable for implant surgery

  • Well maintained and stable periodontal condition

  • No uncontrolled caries

  • No active caries or peri-apical infection on teeth adjacent to proposed implant site

  • A stable occlusal scheme ( a protective bite guard is required in cases where implants are placed in a traumatic occlusion)

  • No other active pathology adjacent to implant site such as tumours, (malignant or benign) or cysts

QUALIFYING PROCEDURES 

STANDARD RISKS COVERED

  • All fixtures placed in healed or healing sites (8 weeks + post extraction) or placed immediately into extraction sockets without loading

  • Immediately loaded cases, single, partial or full where the implant has been placed in healed or healing sites (8 weeks post extraction)

  • With or without Guided Bone Regeneration techniques

  • Delayed loading (more than 3 months post implant placement) of single, partial and full arch cases to include Overdentures

  • Screw or cement retained

  • Straightforward cases as defined by the General Dental Council (GDC) in the document “Training standards in implant dentistry for General Dental practitioners”

 

EXCLUSIONS

Certain medical conditions:

  • Patients on IV bisphosphonates 

  • Patient history of radiation therapy to the jaws

  • Severe immunosuppression

  • Patients undergoing chemotherapy

Certain implant types:

  • One piece implants less than 3.0mm in diameter

  • Implants with a non-roughened / modified surface

  • Zirconia implants

  • Mini implants (implant diameter 2.5 mm or less)

RESPONSIBILITY TO PATIENTS

Dental surgeons to establish:

  • maintenance and oral hygiene programmes for the Patient

  • Dental hygiene visits as as required

IMPLANT SYSTEMS

Only implants approved by the Medicines and Healthcare products Regulatory Agency (MHRA) may be used within the procedure.

OBLIGATIONS FOR PLAN MEMBERS

Plan members undertake to offer a Guarantee provided in the form of an insurance policy to all qualifying patients in respect of qualifying procedures.

This is only a brief description of the full policy details which are contained in the Policy Wordings and which include limitations, exclusions and cancellation rights. If there is any conflict between the contents of this document and the policy, the policy will govern in all cases.