Orthognathic Surgery

Covers orthognathic surgery for correction of maxillary and/or mandibular skeletal deformities and reconstructive facial skeletal procedures when medically necessary to restore function (e.g., persistent masticatory or swallowing impairment) and when specified clinical and numeric thresholds for anteroposterior, vertical, or transverse discrepancies are met. Coverage is limited to members of specified fully insured product types (PPO/HMO/POS, student, small/mid/large group, Medicaid amendments) in Illinois policies amended/issued/renewed on or after 2025‑01‑01, is subject to the member’s benefit contract and state law, and excludes procedures that are cosmetic, correctable non‑surgically, or otherwise excluded by the plan (related TMJ and sleep‑apnea surgeries are covered under separate policies).

"Medically necessary reconstructive services intended to restore the physical appearance of body structures damaged by trauma."