Group Dental Insurance Plan
Exclusions
Exclusions
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No benefits will be paid for expenses incurred:
- For any portion of a charge for any service in excess of the Scheduled Benefit shown in the Schedule of Dental Services.
- For any procedure not listed as a Scheduled Benefit in the Schedule of Dental Services.
- For overdentures and associated procedures.
- For cosmetic procedures, including charges for porcelain or other veneer crowns, pontics, and porcelain or other veneer facings on crowns or pontics to replace molars.
- For the replacement of full and partial dentures, bridges, inlays, on-lays or crowns that can be repaired or restored to normal function.
- For implants; and for (a) the replacement of lost or stolen appliances; (b) the replacement of orthodontic retainers; (c) athletic mouthguard; (d) precision or semi-precision attachments; (e) denture duplication or for; (f) sealants, except as specifically provided in the Schedule of Dental Services.
- For oral hygiene instructions; and for (a) plaque control; (b) the completion of a claim form; (c) acid etch; (d) broken appointments; (e) prescription or take-home flouride; or for (f) diagnostic photographs.
- For services and procedures that are begun, but not completed by the end of the month in which coverage terminates.
- For charges in connection with an orthodontic procedure.
- For charges incurred for treatment which would be given free of charge if you were not insured.
- For charges incurred for treatment which results from a war or an act of war.
- For care and treatment of a condition for which you are entitled to and eligible for benefits under any Worker's Compensation Act or similar law.
- For charges that are applied toward satisfaction of a Deductible, if any.
- For services that are not approved by the Council of Dental Therapeutics of the American Dental Association.
- For charges incurred for treatment which results from intentionally self-inflicted injury.
- For charges incurred for treatment which is given by a person's spouse or his or his spouse's father, mother, son, daughter, brother or sister.
- For charges incurred for treatment which is given by a person's employer or an employee of such employer.
- For charges that are given after a person's insurance ends, regardless of when the injury or sickness occurred.
- For charges that are not essential for the necessary care or treatment of the injury or sickness involved.
- For services that are not recommended, approved and certified as necessary and reasonable by a dentist.
All person who were previously insured for dental insurance under this plan and later voluntarily end insurance will not be eligible to re-enroll for a period of two years following the date insurance was voluntarily ended.