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Exclusions
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Exclusions
Q. Are there expenses which are not covered by the Plan?
A. Although the Plan covers many types of dental treatments and services,
it does not cover all of them
No benefits are payable under the Plan for any charge incurred for:
- Treatment by a person other than a
dentist or
physician, except for services performed by a licensed dental or
medical professional under the direction of a dentist or physician.
- Services not incident to and for the diagnosis or treatment of a condition,
disease or injury while a covered person.
- Services rendered after becoming a participant that
were begun prior to participating even if treatment continues after
you become covered.
- Cosmetic services or supplies, except necessary
reconstructive expenses in connection with treatment of an accidental
injury which begins within 90 days after the accidental injury is sustained.
- Treatment covered by workers' compensation or similar law.
- Professional services rendered by the patient.
- Replacement of a tooth that is missing but unreplaced upon enrollment,
other than a congenitally missing tooth.
- Treatment of any condition with personally
specialized or individually designed services. For example, if you
want a denture
designed with a gap that resembles a gap that existed
in the natural teeth the denture is replacing, the charge for
creating that gap, or for personalizing the denture, is not covered.
- Facings on crowns behind the second bicuspid.
- Training in or supplies used for dietary counseling,
oral hygiene or plaque control.
- Procedures, restorations,
and appliances to increase vertical
dimension, to restore occlusion and to repair attrition
including, but not
limited to, treatment of Temporomandibular Joint Dysfunction (TMJ).
- Services or supplies which are experimental according to
accepted standards of dental practice.
- Post-operative procedures or examinations for which an
additional or separate charge is made.
- Follow-up adjustments of dentures, fixed bridges, or
implants within six months of initial insertion for which an additional
and separate charge is made.
- Temporary crowns or dentures, prior to installation of
permanent devices, for which an additional and separate charge is made.
- Treatment of any condition, disease or injury,
including otherwise covered dental expenses, if the person would not be
required to pay charges had the person not been covered under this Plan,
including services provided in a hospital operated by the United States
or any of its agencies.
- Any charge for a service or supply not listed as a
covered expense.
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