Dental Exclusions Clause Samples
Dental Exclusions. No benefits will be paid for:
Dental Exclusions. No benefits will be paid for:
7.11.1.1 Work in progress on the effective date of coverage. Work in progress is defined as:
Dental Exclusions. No Benefits will be provided under any article of this Plan of Benefits for the following:
1. Any services or charges for services not Medically Necessary;
Dental Exclusions. No benefits will be paid for:
7.11.1.1 Work in progress on the effective date of coverage. Work in progress is defined as:
7.11.1.1.1 A prosthetic or other appliance, or modification of one, where an impression was made before the patient was covered.
7.11.1.1.2 A crown, bridge, or cast restoration for which the tooth was prepared before the patient was covered.
Dental Exclusions. No Benefits will be provided under any article of this Plan of Benefits for the following:
1. Any services or charges for services not Medically Necessary;
2. Dental services or supplies that are Investigational or Experimental;
3. Any charges for supplies or dental services rendered to the Member prior to the Member’s Effective Date, the Employer’s Effective Date or after the Member’s coverage terminates, except as provided in Articles VI and X;
4. Dental services received from a dental or medical department maintained by or on behalf of an Employer, a mutual benefit association, labor union, trustee or similar person or group;
5. Dental services for which the Member incurs no charge;
6. Any service or charge for a service to the extent a Member is entitled to receive payment or benefits relating to such service under any state or federal program that provides healthcare benefits, including, but not limited to, Medicare, TRICARE and Medicaid, but only to the extent that benefits are paid or are payable under such programs. This exclusion includes, but is not limited to, benefits provided by the Veterans Administration for care rendered for service-related disability, or any state or federal hospital services for which the Member is not legally obligated to pay;
7. Dental services or supplies primarily for cosmetic or aesthetic purposes, including personalization or characterization of dentures;
8. Dental services for which the Member would have no legal obligation to pay in the absence of Dental Coverage;
9. Appliances or restorations necessary to increase vertical dimensions or restore the occlusion, including management of TMJ disorders, except as specified on the Schedule of Benefits;
10. Services rendered by a Provider beyond the scope of his or her license;
11. Dental services to the extent that charges for such services exceed the charge that would have been made and actually collected if no coverage hereunder;
12. Charges by a Provider for non-dental services such as broken appointments and completion of claim forms;
13. Charges for visits at home or in the hospital, except in connection with emergency care;
14. Dental care or treatment not specifically listed under Dental Covered Expenses or specified on the Schedule of Benefits;
15. Any service or supply rendered by a member of the patient’s immediate family or by the patient, including the dispensing of drugs. A member of the patient’s family means the Spouse, parent, grandparent, brother, siste...