| Benefits are not
payable for:
Treatment which is not dentally necessary, does not have uniform professional
endorsement or is experimental or investigational in nature; treatment
of the temporomandibular joint; treatment related to changing or maintaining
vertical dimension, altering or restoring occlusion, bite registration
or bite analysis; treatment which does not have a reasonably favorable
prognosis; treatment provided primarily for cosmetic purposes; replacement
of natural teeth missing on the effective date of insurance; orthodontic
treatment, unless such insurance is provided under the list of covered
dental services.
Treatment not included in the list of covered dental services; treatment
started before the date insurance begins; treatment started before any
applicable waiting period has been served; treatment completed after insurance
ends; athletic mouthguards; replacement of lost or stolen appliances; myofunctional
therapy; infection control; oral hygiene instruction; broken appointments;
completion of claim forms; exams required by a third party; travel time;
transportation costs; professional advice given on the phone.
Treatment received due to war, riot, assault or felony; treatment for
a work-related injury; treatment of an intentionally self-inflicted injury;
treatment performed outside of the United States, other than emergency
dental treatment; treatment provided by the person's employer or a member
of the person's immediate family; treatment for which a charge would not
have been made in the absence of insurance; treatment for which the insured
does not have to pay; treatment that has not been both delivered to and
accepted by the insured. |