No service of any dentist other than a Participating General Dentist
or Participating Specialist will be covered by Company, except out-of-area
emergency care as provided in Section VIII, Paragraph C of the Certificate.
Whenever any Contributions or Co-payments are delinquent, Member will not be
entitled to receive Benefits, transfer Dental Facilities, or enjoy
any of the other privileges of a Member in good standing.
Company does not provide coverage for the following services:
a.
Cost of hospitalization and pharmaceuticals, drugs or medications.
b.
Services which in the opinion of the Participating General Dentist or
Participating Specialist are not Necessary Treatment to establish and/or
maintain the Member's oral health.
c.
Any service that is not consistent with the normal and/or usual
services provided by the Participating General Dentist or Participating
Specialist or which in the opinion of the Participating General Dentist
or Participating Specialist would endanger the health of the Member.
d.
Any service or procedure which the Participating General Dentist or
Participating Specialist is unable to perform because of the general
health or physical limitations of the Member.
e.
Any dental treatment started prior to the Member's effective date for
eligibility of benefits.
f.
Services for injuries and conditions which are paid or payable under Workers'
Compensation or Employers' Liability laws.
g.
Treatment for cysts, neoplasms and malignancies.
h.
General anesthesia.
To
submit comments or questions, please visit our Contact Center.
