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.
- 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.
- 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, and to repair attrition including, but not limited to, treatment of Temporomandibular Joint Disorder (TMJ/TMD).
- Services or supplies which are experimental or investigational 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.
- Charges for missed appointments, telephone consultations, and/or completion of claim forms are excluded by the Plan
- Any charge for a service or supply not listed as a covered expense.
- Any charge that exceeds the reasonable and customary limit.
- Any charges deemed to be incidental.