As with all health care plans, there are some services we limit or cannot cover. Since you should understand exactly what you’re buying, we’ve provided a list of limitations and exclusions. This list is standard in the industry. If you have questions, give us a call.

Waiting Periods

No benefits are provided for treatment of Orthodontia for a period of 12 months of consecutive coverage.

General Exclusions

• Aesthetic Dental Procedures: Services and supplies provided in connection with dental procedures that are primarily aesthetic, including bleaching of teeth and labial veneers.
• Antimicrobial Agents: Localized delivery of antimicrobial agents into diseased crevicular tissue via a controlled release vehicle.
• Collection of Cultures and Specimens
• Condition Caused By Active Participation in a War or Insurrection: The treatment of any condition caused by or arising out of a member’s active participation in a war or insurrection.
• Condition Incurred In or Aggravated During Performances In the Uniformed Services: The treatment of any member’s condition that the Secretary of Veterans Affairs determined to have been incurred in, or aggravated during, performance of service in the uniformed services of the United States.
• Connector Bar or Stress Breaker
• Cosmetic/Reconstructive Services and Supplies except for dentally appropriate services and supplies to treat a congenital anomaly and to restore a physical bodily function lost as result of injury or illness.
• Desensitizing: Application of desensitizing medicaments or desensitizing resin for cervical and/or root surface.
• Diagnostic Casts or Study Models
• Duplicate X-Rays
• Expenses Before Coverage Begins or After Coverage Ends: Services and supplies incurred before your effective date under the contract or after your termination under the contract except as may be provided under the other continuation options of the contract.
• Facility Charges: Services and supplies provided in connection with facility services, including hospitalization for dentistry and extended-care facility visits.
• Fees, Taxes, Interest: Charges for shipping and handling, postage, interest or finance charges that a dentist might bill.
• Fractures of the Mandible: Services and supplies provided in connection with the treatment of simple or compound fractures of the mandible.
• Gold-Foil Restorations
• Government Programs: Benefits that are covered, or would be covered in the absence of this plan, by any federal, state or government program.
• Home Visits
• Implants: Services and supplies provided in connection with implants, whether or not the implant itself is covered.
• Investigational Services: Investigational treatment or procedures (health interventions) and services, supplies and accommodations provided in connection with investigational treatments or procedures (health interventions).
• Medications and Supplies including take home drugs, pre-medications, therapeutic drug injections and supplies.
• Motor Vehicle Coverage and Other Insurance Liability
• Nitrous Oxide
• Non-Direct Patient Care including appointments scheduled and not kept, charges for preparing medical reports and visits or consultations that are not in person, including telephone consultations and email exchanges.
• Occlusal Treatment: Services and supplies provided in connection with dental occlusion, including occlusal analysis, adjustments and occlusal guards.
• Oral Hygiene Instructions
• Oral Surgery treating any fractured jaw and orthognathic surgery. By orthognathic surgery, we mean surgery to manipulate facial bones, including the jaw, in patients with facial bone abnormalities performed to restore the proper anatomic and functional relationship of the facial bones.
• Orthodontic Dental Services including correction of malocclusion, craniomandibular orthopedic treatment, other orthodontic treatment, preventive orthodontic procedures and procedures for tooth movement, regardless of purpose. Unless optional orthodontia coverage is selected.
• Personal Comfort Items: Items that are primarily used for personal comfort or convenience, contentment, personal hygiene, aesthetics or other nontherapeutic purposes.
• Photographic Images
• Pin Retention in Addition to Restoration
• Precision Attachments
• Prosthesis including maxillofacial prosthetic procedures and modification of removable prosthesis following implant surgery.
• Provisional Splinting
• Replacements: Services and supplies provided in connection with the replacement of any dental appliance (including, but not limited to, dentures and retainers), whether lost, stolen or broken.
• Riot, Rebellion and Illegal Acts: Services and supplies for treatment of an illness, injury or condition caused by a member's voluntary participation in a riot, armed invasion, aggression, insurrection or rebellion or sustained by a member arising directly from an act deemed illegal by an officer or a court of law.
• Self-Help, Self-Care, Training or Instructional Programs
• Separate Charges: Services and supplies that may be billed as separate charges (these are considered inclusive of the billed procedure) including any supplies, local anesthesia and sterilization.
• Services and Supplies Provided by a Member of Your Family
• Services Performed in a Laboratory
• Surgical Procedures: Services and supplies provided in connection with the following surgical procedures: exfoliative cytology sample collection or brush biopsy; incision and drainage of abscess extraoral soft tissue, complicated or non-complicated; radical resection of maxilla or mandible; removal of nonodontogenic cyst, tumor or lesion; surgical stent and surgical procedures for isolation of a tooth with rubber dam.
• Temporomandibular Joint (TMJ) Dysfunction Treatment: Unless optional TMJ coverage is selected.
• Third-Party Liability: Services and supplies for treatment of illness or injury for which a third party is or may be responsible.
• Tooth Transplantation: Services and supplies provided in connection with tooth transplantation, including reimplantation from one site to another and splinting and/or stabilization.
• Travel and Transportation Expenses
• Work-Related Conditions: Expenses for services and supplies incurred as a result of any work related injury or illness, including any claims that are resolved related to a disputed claim settlement. The only exception is if an enrolled employee is exempt from state or federal workers' compensation law.

This is a brief summary of benefits; it is not a certificate of coverage. For full coverage provisions, refer to the contract.