* for services performed solely for cosmetic
reasons.
* for crowns for teeth that can be restored by
other means, or for the purpose of periodontal splinting.
* for any service or procedure relating to:
a. the change of vertical dimension;
b. restoration of occlusion;
c. bite registration; or
d. bite analysis.
* for the initial placement of full or partial
dentures, or bridges, if it includes the replacement of teeth all of
which are missing before the COVERED PERSON
becomes insured for this benefit. But this will
not apply if the prosthesis replaces a functioning tooth which is
extracted while insured.
* for the replacement of bridges; full or
partial dentures; inlays; or crowns within five years of the date of
insertion unless the replacement is made necessary by:
a. COVERED DENTAL INJURY to sound natural
teeth, or
b. the extraction of functioning natural
teeth while insured for this benefit.
* for the replacement of bridges; full or
partial dentures; crowns; or inlays if they can be repaired.
* for surgical implants.
* for or in connection with any of the
following:
a. replacement of lost or stolen appliances;
b. athletic mouthguards;
c. precision or semi-precision attachments or
other customized denture construction;
d. denture duplication; or
e. oral hygiene instruction
* for any orthodontic treatment except as
provided under any Separate Benefit for Orthodontic Expenses in the
olicy.
* for orthognathic surgery.
* for surgical treatment of the
temporomandibular joint.
* for services which are covered expenses under
any medical care plan provided by the EMPLOYER.
* IN ANY INSTITUTION:
a. owned or run by a national government or
any agency thereof, or
b. owned or run by a state government unless
the COVERED PERSON would have to pay the charges if he did not
have insurance.
* which the COVERED PERSON is not legally
required to pay
* as a result of WAR
* for services performed by the employee or the
employee's spouse, or by a sibling, parent, or child of either.
* for sickness for which the COVERED PERSON is
entitled to benefits under a Worker's Compensation Act or similar law.
* for injury arising out of or in the course of
a COVERED PERSON'S employment with any employer or self-employment.
* to the extent they exceed the amount
determined from the Dental Service Schedule.
