TMJ Treatment

The plan covers diagnostic and surgical and non-surgical treatment of conditions affecting the temporomandibular joint (TMJ) when provided by or under the direction of a physician.

Coverage includes necessary treatment required as a result of accident, trauma, a congenital anomaly, developmental defect, or pathology. Diagnostic treatment includes examination, radiographs and applicable imaging studies and consultation. Non-surgical treatment includes clinical examinations, oral appliances (orthotic splints), arthrocentesis and trigger-point injections. Coverage is not provided for any orthodontic and prosthetics devices, including but not limited to braces or mouth guards.

Benefits are provided for surgical treatment if:

  • there is clearly demonstrated radiographic evidence of significant joint abnormality;
  • non-surgical treatment has failed to adequately resolve the symptoms;
  • and pain or dysfunction is moderate or severe.

Benefits for surgical services include arthrocentesis, arthroscopy, arthroplasty, arthrotomy, open or closed reduction of dislocations.

  • Coverage for non-surgical treatment is limited to $2,000 per covered person per lifetime.
  • Coverage is limited to one surgical session per covered person per lifetime.

If the student is seen at an in-network provider, Student Health Services will pay 80% of the reasonable and customary covered expenses and the student will be responsible for 20% of such expenses.