Medical Policy and Dental Policy -- Terms and Conditions

Our policy manuals are available at: 

• Medical Policy Manual: http://blue.regence.com/trgmedpol/intro.html
• Dental Policy Manual: http://blue.regence.com/about/dental/

By viewing the manuals, you understand and agree to the following terms and conditions:

Description
The Medical Policy and Dental Policy manuals contain policies approved by Asuris. Medical policies are based upon scientific evidence of merit for a particular medical technology. Dental Policies have been developed through consideration of government approval status, dental necessity, generally accepted standards of dental practice, and review of dental literature.

Use
Asuris uses medical, dental and behavioral health policies as guidelines for coverage determinations in all health care insurance products, unless otherwise indicated.

Conflict with Plan Documents
In the event of a conflict between Medical Policy or Dental Policy and any Plan document under which a member is entitled to Covered Services, the Plan document will govern. Plan documents include, but are not limited to, Subscriber Contracts, Summary Plan Documents, and other coverage documents prepared by a Plan.

Restrictions and Limitations

• Medical and Dental Policies DO NOT determine the schedule of benefits. Rather, Medical and Dental Policies are used in the process of determining whether a service may be medically necessary or investigational.
• Medical and Dental Policies are interpreted and applied in the sole discretion of the Plan.
• Medical and Dental Policies application is subject to state and federal laws and specific instructions from Plan Sponsors of self-insured groups.
• Medical and Dental Policies DO NOT constitute medical, dental or behavioral health advice and DO NOT guarantee any results or outcomes. You should discuss any health care questions related to these Medical and Dental Policies with your health care provider.
• Current Procedural Terminology (CPT^®) codes and descriptions are the property of the American Medical Association with all rights reserved.
• Current Dental Terminology (CDT^®) codes and descriptions are the property of the American Dental Association with all rights reserved.
• Medical and Dental Policies are the property of Asuris, but may be used for purposes related to the health care of a Asuris Plan member. You are strictly prohibited from using Medical and Dental Policiess for purposes not related to the health care of a Asuris Plan member, including but not limited to commercial use.