Excluded Dental Benefits

Covered dental charges do not include charges for services and supplies:

Not ordered by a dentist;
In a veterans administration hospital;
Due to the loss of theft of an appliance;
Which an insured person would not legally have to pay if there was no insurance;
Due to war, if declared or not;
From a health department maintained by an employer, a union, a trustee or similar type of entity;
Which are payable by a local or other agency of government;
For cosmetic reasons, including altering or extracting and replacing sound teeth to change appearance;
For more than one routine oral examination with respect to the same insured person during any 6-month period;
Performed by a member of an insured person's immediate family;
Instructions for plaque control, oral hygiene or diet;
For installing for the first time or for adding to a denture or fixed bridge unless:

The work is needed due to extraction of injured or diseased natural teeth and is finished within 12 months of the date the tooth was extracted; and,
The tooth is extracted while the person is insured for these benefits; and,
The work includes replacing the extracted tooth;

NOTE: a denture or bridge is considered to be installed for the first time if it does not replace any existing denture or bridge.

An accidental injury requiring oral surgery; or,
Oral surgery which involves changing the position of muscle attachments or removing a tumor, cyst, torus or excess tissue; and,

For replacing a full denture unless needed due to a change in the structure of the mouth if replaced after the latter of:

For an injury or sickness due to employment with any employer or if self employed;
For orthodontic appliances and treatment, unless incurred during a course of orthodontic treatment which begins while the person is insured for these benefits;
For non-emergency treatment outside the U.S.