IBM Japan Health Insurance Association

IBM Japan Health Insurance Association

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Dental treatment

Insurance usually covers all dental treatment.
However, you must make payments out of pocket for treatment not covered by insurance, including orthodontics to straighten your teeth or for use of materials not covered by insurance. This includes gold whose grade exceeds 14 karats.
For metal false teeth, you will need in some cases to pay just the difference between the cost of treatment covered by insurance and treatment not covered by insurance. Discuss all your options with your dentist before beginning treatment to avoid difficulties later.

Maintenance and management expenses for crown and bridge

When you use insurance for treatment, including metal crown work (not including inlays), resin caps for front teeth, jacket crowns, or bridges, some dentists will add maintenance and management expenses for the crown and bridge to the costs of treatment. In such cases, if you need new dental work within two years because the original work broke, you will not have to pay the examination costs, manufacturing costs, or installation costs for the new work. (This does not include charges for the first consultation or other treatment costs, and it does not apply to children of less than six years of age or to house calls.)

If these maintenance and management costs are not added to the initial cost and you need new dental work within two years, you will generally be required to pay 70% of the examination costs, manufacturing costs, and installation costs for the new work.

Scope and details of treatment covered by insurance
Filling Metal crown work (e.g., inlays)
This method involves cleaning the cavity and filling it with cement, hard resin, or other material to restore the shape of the tooth
This method restores the tooth’s original shape by grinding it and inserting a crown modeled on the original tooth. (You must make payments out of pocket for treatment methods that involve the use of ceramics, gold alloys, and gold platinum alloys. However, when using gold alloys or gold platinum alloys on a front tooth, you are responsible for paying just the difference in cost between those materials and the materials covered by insurance.)
Resin caps for front teeth Jacket crowns

This method involves covering the surface of a metal crown with hard resin, to treat a large cavity on a front tooth that cannot be restored using a filling or an inlay.

(You must make payments out of pocket for treatment methods, including metal bonding, porcelain crowns, and, for front molars, hard resin caps.)

This method, used for front teeth and premolars, involves covering the entire surface of the crown using a resin material, colored like the natural tooth.

(You must make payments out of pocket for porcelain and glass ceramic materials.)

Bridge Dentures
This method involves grinding the teeth adjacent to a missing tooth and using them as the foundation for installing an artificial tooth.
(You must make payments out of pocket for treatment methods, including use of gold alloys and gold platinum alloys, metal bonding and, for front molars, porcelain hard resin caps.)
These are removable false teeth. There are two types: partial dentures used when only some teeth are missing and full dentures used when all teeth are missing.
(Only dentures whose overall structure is made of metal are covered. You must make payments out of pocket for clasps made of gold alloys or gold platinum alloys whose grade exceeds 14 karats and for some types of fixtures used to keep the dentures in place. However, for metal false teeth, you may need to pay just the difference in amounts between treatment covered by insurance and treatment not covered.)

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