 | Oral surgery requiring the setting of fractures or dislocations. |
| Treatment of congenital malformations. |
| Treatment of malignancies. |
| Dispensing of drugs. |
| Any treatment requiring hospitalization. |
| Any work which is not able to be performed because of the
general health and physical limits of the eligible member, as indicated by said
member's personal physician or the OHS dentist. |
| Precision attachments or stress breakers. |
| Replacement of partial or full dentures within two (2) years
after installation unless resulting from the acts or missions of OHS. |
| Any treatment paid for by Worker's Compensation or covered
or provided for by employer's liability laws, by a federal or state government
agency, or provided without cost by any municipality, county or other political
subdivision. |
| Any procedure, implantation and/or any dental procedure
considered to be experimental by the providing dentist. |
| General anesthesia. |
| Surgical treatment or Temporomandibular Joint Dysfunction
(TMJ). |
| Replacement of lost or stolen prosthetic devices. |
| Any dental care provided by a non-participating general
dentist or specialist, except when authorized by OHS. |
| Services resulting from any act or war, declared or not,
or resulting from military service. |
| Charges for broken appointment are not covered. |
| The participating Dentist shall have their right to refuse
treatment to a member who fails to follow a prescribed course of treatment. |
| Published member co-payments apply only when Treatment is
performed at a Participating Dental Office. |
| If a member obtains dental services fro other than Participating
Dentist/Specialist, the member shall be responsible for all costs. |
| Members are eligible to receive any listed covered service
on this Benefit Schedule when it has been determined that it is correct and appropriate
care and has been prescribed by their OHS participating dentist. |
| Not all participating dentists perform all listed procedures.
Please consult your dentist prior to treatment for availability of services. |
| Treatment in progress prior the effective date of coverage
is not covered, with the exception of orthodontic treatment. |
