Common use of Exclusions and Limitations Clause in Contracts

Exclusions and Limitations. The Services listed in this “Exclusions and Limitations” section are either completely excluded from coverage or partially limited under this EOC. These exclusions and limitations apply to all Services that would otherwise be covered under this EOC and are in addition to the exclusions and limitations that apply only to a particular Service as listed in the description of that Service in this EOC. Exclusions  Cosmetic Services, supplies, or prescription drugs that are intended primarily to improve appearance, repair, and/or replace cosmetic dental restorations.  Dental conditions for which Service or reimbursement is required by law to be provided at or by a government agency.  Dental implants, including bone augmentation and fixed or removable prosthetic devices attached to or covering the implants; all related Services, including diagnostic consultations, impressions, oral surgery, placement, removal, and cleaning when provided in conjunction with dental implants; and Services associated with postoperative conditions and complications arising from implants, unless your Group has purchased coverage for dental implants as an additional benefit.  Dental Services not listed in the “Benefits” section.  Drugs obtainable with or without a prescription. These may be covered under your medical benefits.  Experimental or investigational treatments, procedures, and other Services that are not commonly considered standard dental practice or that require governmental approval.  Fees a provider may charge for an Emergency Dental Care or Urgent Dental Care visit.  Full mouth reconstruction and occlusal rehabilitation, including appliances, restorations, and procedures needed to alter vertical dimension, occlusion, or correct attrition or abrasion.  Genetic testing.  “Hospital call fees,” “call fees” or similar Charges associated with Dentally Necessary Services that are performed at ambulatory surgical centers or hospitals.  Medical or Hospital Services, unless otherwise specified in the EOC.  Missed appointment fees a provider may charge for a missed appointment.  Orthodontic Services, unless your Group has purchased orthodontic coverage as an additional benefit.  Prosthetic devices following your decision to have a tooth (or teeth) extracted for nonclinical reasons or when a tooth is restorable.  Replacement of prefabricated, noncast crowns, including noncast stainless steel crowns that were not placed by a Participating Provider.  Services for conditions that are covered by workers’ compensation or that are the employer’s responsibility.  Services furnished by a family member.  Services provided or arranged by criminal justice institutions for Members confined therein, unless care would be covered as Emergency Dental Care.  Speech aid prosthetic devices and follow up modifications.  Surgery to correct malocclusion or temporomandibular joint disorders; treatment for problems of the jaw joint, including temporomandibular joint syndrome and craniomandibular disorders; and treatment of conditions of the joint linking the jaw bone and skull and of the complex of muscles, nerves, and other tissues related to that joint.  Treatment to restore tooth structure lost due to attrition, erosion, or abrasion.

Exclusions and Limitations. The Services listed in this “Exclusions and Limitations” section are either completely excluded from coverage or partially limited under this EOC. These exclusions and limitations apply to all Services that would otherwise be covered under this EOC and are in addition to the exclusions and limitations that apply only to a particular Service as listed in the description of that Service in this EOC. Exclusions  Additional fees a Non-Participating Provider may charge for an Emergency Dental Care or Urgent Dental Care visit after our payment for covered Services. Continuation of Services performed or started prior to your coverage becoming effective. Continuation of Services performed or started after your membership terminates. Cosmetic Services, supplies, or prescription drugs that are intended primarily to improve appearance, repair, and/or replace cosmetic dental restorations.  Dental conditions for which Service or reimbursement is required by law to be provided at or by a government agency.  We do not reimburse the government agency for any Services that the law requires be provided only by or received only from a government agency. When we cover any of these Services, we may recover the Charges for the Services from the government agency. This exclusion does not apply to Medicaid. Dental implants, including bone augmentation and fixed or removable prosthetic devices attached to or covering the implants; all related Services, including diagnostic consultations, impressions, oral surgery, placement, removal, and cleaning when provided in conjunction with dental implants; and Services associated with postoperative conditions and complications arising from implants, unless your Group has purchased coverage for dental implants as an additional benefit.  Dental Services not listed in the “Benefits” sectionsection of this EOC.  Drugs obtainable with or without a prescription. These may be covered under your medical benefits.  Experimental or investigational treatments, procedures, and other Services that are not commonly considered standard dental practice or that require governmental U.S. Food and Drug Administration (FDA) approval.  A Service is experimental or investigational if: • the Service is not recognized in accordance with generally accepted dental standards as safe and effective for use in treating the condition in question, whether or not the Service is authorized by law for use in testing, or other studies on human patients: or • the Service requires approval by FDA authority prior to use and such approval has not been granted when the Service is to be rendered. Fees a provider may charge for an Emergency Dental Care or Urgent Dental Care visita missed appointment.  Full mouth reconstruction and reconstruction, including, but not limited to, occlusal rehabilitation, including appliances, restorations, and procedures needed to alter vertical dimension, occlusion, or correct attrition or abrasion.  Genetic testing.  “Hospital call fees,” “call fees” or similar Charges associated with Dentally Necessary Services that are performed at ambulatory surgical centers or hospitalsMaxillofacial surgery.  Medical or Hospital Services, unless otherwise specified in the EOC.  Missed appointment fees a provider may charge Myofunctional therapy. Non-orthodontic recording of jaw movements or positions. Orthodontic treatment of primary/transitional dentition. Orthognathic surgery. Procedures, appliances, or fixed crowns and bridges for a missed appointmentperiodontal splinting of teeth.  Orthodontic Services, unless your Group has purchased orthodontic coverage as an additional benefit.  Prosthetic devices following your decision to have extraction of a tooth (or of teeth) extracted for nonclinical reasons or when a tooth is restorable.  Replacement of lost or damaged space maintainers. Replacement of prefabricated, noncast crowns, including noncast stainless steel crowns that were not placed crowns, except when the Member has five or more years of continuous dental coverage with Company. Services performed by someone other than a Participating Provider or Non-Participating Provider.  Services for conditions that are covered by workers’ compensation or that are the employer’s responsibility.  Services furnished by a family member.  Services provided or arranged by criminal justice institutions for Members confined therein, unless care would be covered as Emergency Dental Care.  Speech aid prosthetic devices and follow up modifications.  Surgery to correct malocclusion or temporomandibular joint (TMJ) disorders; treatment for problems of the jaw joint, including temporomandibular joint (TMJ) syndrome and craniomandibular disorders; and treatment of conditions of the joint linking the jaw bone and skull and of the complex of muscles, nerves, and other tissues related to that joint.  Treatment of cleft palate. Treatment of macroglossia. Treatment of micrognathia. Treatment to restore tooth structure lost due to attrition, erosion, or abrasion. Use of alternative materials for the removal and replacement of clinically acceptable material or restorations is not covered for any reason, except when the pathological condition of the tooth (or teeth) warrants replacement.

Exclusions and Limitations. The Services listed in this “Exclusions and Limitations” section are either completely excluded from coverage or partially limited under this EOC. These exclusions and limitations apply to all Services that would otherwise be covered under this EOC and are in addition to the exclusions and limitations that apply only to a particular Service as listed in the description of that Service in this EOC. Exclusions  Additional fees a Non-Participating Provider may charge for an Emergency Dental Care or Urgent Dental Care visit after our payment for covered Services. Continuation of Services performed or started prior to your coverage becoming effective. Continuation of Services performed or started after your membership terminates. Cosmetic Services, supplies, or prescription drugs that are intended primarily to improve appearance, repair, and/or replace cosmetic dental restorations.  Dental conditions for which Service or reimbursement is required by law to be provided at or by a government agency.  Dental implants, including bone augmentation and fixed or removable prosthetic devices attached to or covering the implants; all related Services, including diagnostic consultations, impressions, oral surgery, placement, removal, and cleaning when provided in conjunction with dental implants; and Services associated with postoperative conditions and complications arising from implants, unless your Group has purchased coverage for dental implants as an additional benefit.  Dental Services not listed in the “Benefits” sectionsection of this EOC.  Drugs obtainable with or without a prescription. These may be covered under your medical benefits.  Experimental or investigational treatments, procedures, and other Services that are not commonly considered standard dental practice or that require governmental United States Food and Drug Administration (FDA) approval.  A Service is experimental or investigational if: • the Service is not recognized in accordance with generally accepted dental standards as safe and effective for use in treating the condition in question, whether or not the Service is authorized by law for use in testing, or other studies on human patients: or • the Service requires approval by FDA authority prior to use and such approval has not been granted when the Service is to be rendered. Fees a provider may charge for an Emergency Dental Care or Urgent Dental Care visita missed appointment.  Full mouth reconstruction and reconstruction, including, but not limited to, occlusal rehabilitation, including appliances, restorations, and procedures needed to alter vertical dimension, occlusion, or correct attrition or abrasion.  Genetic testing.  Government agency responsibility, we do not reimburse the government agency for any Services that the law requires be provided only by or received only from a government agency. When we cover any of these Services, we may recover the Charges for the Services from the government agency. However, this exclusion does not apply to Medicaid. “Hospital call fees,” “call fees” or similar Charges associated with Dentally Necessary Services that are performed at ambulatory surgical centers or hospitals.  Maxillofacial surgery. Medical or Hospital Services, unless otherwise specified in the EOC.  Missed appointment fees a provider may charge for a missed appointmentMyofunctional therapy.  Non-orthodontic recording of jaw movements or positions. Orthodontic Services, unless your Group has purchased orthodontic coverage as an additional benefit.  Orthodontic treatment of primary/transitional dentition. Orthognathic surgery. Procedures, appliances, or fixed crowns and bridges for periodontal splinting of teeth. Prosthetic devices following your decision to have extraction of a tooth (or of teeth) extracted for nonclinical reasons or when a tooth is restorable.  Replacement of lost or damaged space maintainers. Replacement of prefabricated, noncast crowns, including noncast stainless steel crowns that were not placed crowns, except when the Member has five or more years of continuous dental coverage with Company. Services performed by someone other than a Participating Provider or Non-Participating Provider.  Services for conditions that are covered by workers’ compensation or that are the employer’s responsibility.  Services furnished by a family member.  Services provided or arranged by criminal justice institutions for Members confined therein, unless care would be covered as Emergency Dental Care.  Speech aid prosthetic devices and follow up modifications.  Surgery to correct malocclusion or temporomandibular joint (TMJ) disorders; treatment for problems of the jaw joint, including temporomandibular joint (TMJ) syndrome and craniomandibular disorders; and treatment of conditions of the joint linking the jaw bone and skull and of the complex of muscles, nerves, and other tissues related to that joint.  Treatment of cleft palate. Treatment of macroglossia. Treatment of micrognathia. Treatment to restore tooth structure lost due to attrition, erosion, or abrasion. Use of alternative materials for removal and replacement of clinically acceptable material or restorations for any reason, except the pathological condition of the tooth (or teeth).

Exclusions and Limitations. The Services listed in this “Exclusions and Limitations” section are either completely excluded from coverage or partially limited under this EOC. These exclusions and limitations apply to all Services that would otherwise be covered under this EOC and are in addition to the exclusions and limitations that apply only to a particular Service as listed in the description of that Service in this EOC. Exclusions  Cosmetic Services, supplies, or prescription drugs that are intended primarily to improve appearance, repair, and/or replace cosmetic dental restorations.  Dental conditions for which Service or reimbursement is required by law to be provided at or by a government agency.  Dental implants, including bone augmentation and fixed or removable prosthetic devices attached to or covering the implants; all related Services, including diagnostic consultations, impressions, oral surgery, placement, removal, and cleaning when provided in conjunction with dental implants; and Services associated with postoperative conditions and complications arising from implants, unless your Group has purchased coverage for dental implants as an additional benefit.  Dental Services not listed in the “Benefits” section.  Drugs obtainable with or without a prescription. These may be covered under your medical benefits.  Experimental or investigational treatments, procedures, and other Services that are not commonly considered standard dental practice or that require governmental approval.  Fees a provider may charge for an Emergency Dental Care or Urgent Dental Care visit.  Full mouth reconstruction and occlusal rehabilitation, including appliances, restorations, and procedures needed to alter vertical dimension, occlusion, or correct attrition or abrasion.  Genetic testing.  “Hospital call fees,” “call fees” or similar Charges associated with Dentally Necessary Services that are performed at ambulatory surgical centers or hospitals.  Medical or Hospital Services, unless otherwise specified in the EOC.  Missed appointment fees a provider may charge for a missed appointment.  Orthodontic Services, unless your Group has purchased orthodontic coverage as an additional benefit.  Prosthetic devices following your decision to have a tooth (or teeth) extracted for nonclinical reasons or when a tooth is restorable.  Replacement of prefabricated, noncast crowns, including noncast stainless steel crowns that were not placed by a Participating Provider.  Services for conditions that are covered by workers’ compensation or that are the employer’s responsibility.  Services furnished by a family member.  Services provided or arranged by criminal justice institutions for Members confined therein, unless care would be covered as Emergency Dental Care.  Speech aid prosthetic devices and follow up modifications.  Surgery to correct malocclusion or temporomandibular joint disorders; treatment for problems of the jaw joint, including temporomandibular joint syndrome and craniomandibular disorders; and treatment of conditions of the joint linking the jaw bone and skull and of the complex of muscles, nerves, and other tissues related to that joint.  Treatment to restore tooth structure lost due to attrition, erosion, or abrasion.

Exclusions and Limitations. The Services listed in this “Exclusions and Limitations” section are either completely excluded from coverage or partially limited under this EOC. These charts below detail special exclusions and limitations apply to all Services that would otherwise be this warranty. Warranty Term Exclusions Warranty Period Air filters, auger paddles, brake arms, brake linings, brake shoes, brushes, cutters, fuel filters, headlights, knives, light bulbs, lubricants, mower blades, oil, oil filters, spark plugs, scraper blades, shear bolts and skid shoes. Components are not covered under this EOC warranty. See Hydro-Gear warranty. The warranty is administrated by Ariens Company. Hydro-Gear Transaxle Limitation Warranty Term Limitations Warranty Period Cloth, Plastic and Rubber Components. Mufflers, Tires, Belts and Cables. 2 Years Residential Use. No Commercial Warranty. Components are in addition to the exclusions and limitations that apply only to a particular Service as listed in the description of that Service in this EOCcovered for manufacturer’s defect only, not wear. Exclusions  Cosmetic Services, supplies, or prescription drugs that are intended primarily to improve appearance, repair, and/or replace cosmetic dental restorations.  Dental conditions for which Service or reimbursement is required – Items Not Covered by law to be provided at or by a government agency.  Dental implants, including bone augmentation and fixed or removable prosthetic devices attached to or covering the implants; all related Services, including diagnostic consultations, impressions, oral surgery, placement, removal, and cleaning when provided in conjunction with dental implants; and Services associated with postoperative conditions and complications arising from implants, unless your Group has purchased coverage for dental implants as an additional benefit.  Dental Services not listed in the “Benefits” section.  Drugs obtainable with or without a prescription. These may be covered under your medical benefits.  Experimental or investigational treatments, procedures, and other Services This Warranty • Parts that are not commonly considered standard dental practice genuine Ariens service parts are not covered by this warranty and may void the war- ranty if the parts result in premature wear or that require governmental approvaldamage to the product.  Fees a provider may charge for an Emergency Dental Care • Damages resulting from the installation or Urgent Dental Care visit.  Full mouth reconstruction and occlusal rehabilitationuse of any part, including appliances, restorations, and procedures needed to alter vertical dimension, occlusionaccessory, or correct attrition attachment which is not approved by the Ariens Company for use with product(s) identified herein are not covered by this warranty. • Any misuse, alteration, improper assembly, improper adjustment, neglect, or abrasionaccident which requires repair is not covered by this warranty.  Genetic testing• Repairs or adjustments required due to failure to use fresh fuel or failure to properly prepare the unit for periods of non-use.  “Hospital call fees,” “call fees” or similar Charges associated with Dentally Necessary Services that • Use of gasoline blends exceeding 10% ethanol voids any and all warranties. • Products are performed at ambulatory surgical centers or hospitals.  Medical or Hospital Services, unless otherwise specified designed to the specifications in the EOCarea that the product was originally distributed.  Missed appointment fees a provider Differ- ent areas may charge have significantly different legal and design requirements. This warranty is limited to the requirements in the area in which the unit was originally distributed. Ariens Company does not warrant this product to the requirements of any other area. Warranty service is limited to service within the area originally distributed. • In countries other than the United States and Canada, contact the Ariens Company dealer for a missed appointmentwarranty policies that govern within your country.  Orthodontic Services, unless your Group has purchased orthodontic coverage as an additional benefit.  Prosthetic devices following your decision Rights may vary from country to have a tooth (or teeth) extracted for nonclinical reasons or when a tooth is restorable.  Replacement of prefabricated, noncast crowns, including noncast stainless steel crowns that were not placed by a Participating Provider.  Services for conditions that are covered by workers’ compensation or that are the employer’s responsibility.  Services furnished by a family member.  Services provided or arranged by criminal justice institutions for Members confined therein, unless care would be covered as Emergency Dental Care.  Speech aid prosthetic devices country and follow up modifications.  Surgery to correct malocclusion or temporomandibular joint disorders; treatment for problems of the jaw joint, including temporomandibular joint syndrome and craniomandibular disorders; and treatment of conditions of the joint linking the jaw bone and skull and of the complex of muscles, nerves, and other tissues related to that joint.  Treatment to restore tooth structure lost due to attrition, erosion, or abrasionwithin any one country.

Exclusions and Limitations. The Services listed in this “Exclusions and Limitations” section are either completely excluded from coverage or partially limited under this EOC. These exclusions and limitations apply to all Services that would otherwise be covered under this EOC and are in addition to the exclusions and limitations that apply only to a particular Service as listed in the description of that Service in this EOC. Exclusions  Continuation of Services performed or started prior to your coverage becoming effective.  Continuation of Services performed or started after your membership terminates.  Cosmetic Services, supplies, or prescription drugs that are intended primarily to improve appearance, repair, and/or replace cosmetic dental restorations.  Dental conditions for which Service or reimbursement is required by law to be provided at or by a government agency.  Dental implants, including bone augmentation and fixed or removable prosthetic devices attached to or covering the implants; all related Services, including diagnostic consultations, impressions, oral surgery, placement, removal, and cleaning when provided in conjunction with dental implants; and Services associated with postoperative conditions and complications arising from implants, unless your Group has purchased coverage for dental implants as an additional benefit.  Dental Services not listed in the “Benefits” section.  Drugs obtainable with or without a prescription. These may be covered under your medical benefits.  Experimental or investigational treatments, procedures, and other Services that are not commonly considered standard dental practice or that require governmental approval.  Fees a provider may charge for an Emergency Dental Care or Urgent Dental Care visit.  Full mouth reconstruction and occlusal rehabilitation, including appliances, restorations, and procedures needed to alter vertical dimension, occlusion, or correct attrition or abrasion.  Genetic testing.  “Hospital call fees,” “call fees” or similar Charges associated with Dentally Necessary Services that are performed at ambulatory surgical centers or hospitals.  Medical or Hospital Services, unless otherwise specified in the EOC.  Missed appointment fees a provider may charge for a missed appointment.  Orthodontic Services, unless your Group has purchased orthodontic coverage as an additional benefit.  Prosthetic devices following your decision to have a tooth (or teeth) extracted for nonclinical reasons or when a tooth is restorable.  Replacement of prefabricated, noncast crowns, including noncast stainless steel crowns that were not placed by a Participating Provider.  Services for conditions that are covered by workers’ compensation or that are the employer’s responsibility.  Services furnished by a family member.  Services provided or arranged by criminal justice institutions for Members confined therein, unless care would be covered as Emergency Dental Care.  Speech aid prosthetic devices and follow up modifications.  Surgery to correct malocclusion or temporomandibular joint disorders; treatment for problems of the jaw joint, including temporomandibular joint syndrome and craniomandibular disorders; and treatment of conditions of the joint linking the jaw bone and skull and of the complex of muscles, nerves, and other tissues related to that joint.  Treatment to restore tooth structure lost due to attrition, erosion, or abrasion.

Exclusions and Limitations. The Services listed in this “Exclusions and Limitations” section are either completely excluded from coverage or partially limited under this EOC. These exclusions and limitations apply to all Services that would otherwise be covered under this EOC and are in addition to the exclusions and limitations that apply only to a particular Service as listed in the description of that Service in this EOC. Exclusions  Continuation of Services performed or started prior to your coverage becoming effective.  Continuation of Services performed or started after your membership terminates.  Cosmetic Services, supplies, or prescription drugs that are intended primarily to improve appearance, repair, and/or replace cosmetic dental restorations.  Dental conditions for which Service or reimbursement is required by law to be provided at or by a government agency.  Dental implants, including bone augmentation and fixed or removable prosthetic devices attached to or covering the implants; all related Services, including diagnostic consultations, impressions, oral surgery, placement, removal, and cleaning when provided in conjunction with dental implants; and Services associated with postoperative conditions and complications arising from implants, unless your Group has purchased coverage for dental implants as an additional benefit.  Dental Services not listed in the “Benefits” sectionsection of this EOC.  Drugs obtainable with or without a prescription. These may be covered under your medical benefits.  Experimental or investigational treatments, procedures, and other Services that are not commonly considered standard dental practice or that require United States Food and Drug Administration (FDA) governmental approval. A Service is experimental or investigational if: • the Service is not recognized in accordance with generally accepted dental standards as safe and effective for use in treating the condition in question, whether or not the Service is authorized by law for use in testing, or other studies on human patients: or • the Service requires approval by FDA authority prior to use and such approval has not been granted when the Service is to be rendered.  Fees a provider may charge for an Emergency Dental Care or Urgent Dental Care visit.  Fees a provider may charge for a missed appointment.  Full mouth reconstruction and occlusal rehabilitation, including appliances, restorations, and procedures needed to alter vertical dimension, occlusion, or correct attrition or abrasion.  Genetic testing.  Government agency responsibility, we do not reimburse the government agency for any Services that the law requires be provided only by or received only from a government agency. When we cover any of these Services, we may recover the Charges for the Services from the government agency. However, this exclusion does not apply to Medicaid.  “Hospital call fees,” “call fees” or similar Charges associated with Dentally Necessary Services that are performed at ambulatory surgical centers or hospitals.  Maxillofacial surgery.  Medical or Hospital Services, unless otherwise specified in the EOC.  Missed appointment fees a provider may charge for a missed appointmentMyofunctional therapy.  Non-orthodontic recording of jaw movements or positions.  Orthodontic Services, unless your Group has purchased orthodontic coverage as an additional benefit.  Orthognathic surgery.  Procedures, appliances, or fixed crown and bridge for periodontal splinting of teeth.  Prosthetic devices following your decision to have extraction of a tooth (or of teeth) extracted for nonclinical reasons or when a tooth is restorable.  Replacement of broken orthodontic appliances.  Replacement of prefabricated, noncast crowns, including noncast stainless steel crowns that were not placed by a Participating Provider.  Services for conditions that are covered by workers’ compensation crowns, except when the Member has five or that are the employer’s responsibility.  Services furnished by a family member.  Services provided or arranged by criminal justice institutions for Members confined therein, unless care would be covered as Emergency Dental Caremore years of continuous dental coverage with Company.  Speech aid prosthetic devices and follow up modifications.  Surgery to correct malocclusion or temporomandibular joint disorders; treatment for problems of the jaw joint, including temporomandibular joint syndrome and craniomandibular disorders; and treatment of conditions of the joint linking the jaw bone and skull and of the complex of muscles, nerves, and other tissues related to that joint.  Treatment to restore tooth structure lost due to attrition, erosion, or abrasion.

Exclusions and Limitations. The Services listed in this “Exclusions and Limitations” section are either completely excluded from coverage or partially limited under this EOC. These exclusions and limitations apply to all Services that would otherwise be covered under this EOC and are in addition to the exclusions and limitations that apply only to a particular Service as listed in the description of that Service in this EOC. Exclusions  Cosmetic Services, supplies, or prescription drugs that are intended primarily to improve appearance, repair, and/or replace cosmetic dental restorations.  Dental conditions for which Service or reimbursement is required by law to be provided at or by a government agency.  Dental implants, including bone augmentation and fixed or removable prosthetic devices attached to or covering the implants; all related Services, including diagnostic consultations, impressions, oral surgery, placement, removal, and cleaning when provided in conjunction with dental implants; and Services associated with postoperative conditions and complications arising from implants, unless your Group has purchased coverage for dental implants as an additional benefit.  Dental Services not listed in the “Benefits” section.  Drugs obtainable with or without a prescription. These may be covered under your medical benefits.  Experimental or investigational treatments, procedures, and other Services that are not commonly considered standard dental practice or that require governmental approval.  Fees a provider may charge for an Emergency Dental Care or Urgent Dental Care visit.  Full mouth reconstruction and occlusal rehabilitation, including appliances, restorations, and procedures needed to alter vertical dimension, occlusion, or correct attrition or abrasion.  Genetic testing.  “Hospital call fees,” “call fees” or similar Charges associated with Dentally Necessary Services that are performed at ambulatory surgical centers or hospitals.  Medical or Hospital Services, unless otherwise specified in the EOC.  Missed appointment fees a provider may charge for a missed appointment.  Orthodontic Services, unless your Group has purchased orthodontic coverage as an additional benefit.  Prosthetic devices following your decision to have a tooth (or teeth) extracted for nonclinical reasons or when a tooth is restorable.  Replacement of prefabricated, noncast crowns, including noncast stainless steel crowns that were not placed by a Participating Provider.  Services for conditions that are covered by workers’ compensation or that are the employer’s responsibility.  Services furnished by a family member.  Services provided or arranged by criminal justice institutions for Members confined therein, unless care would be covered as Emergency Dental Care.  Speech aid prosthetic devices and follow up modifications.  Surgery to correct malocclusion or temporomandibular joint disorders; treatment for problems of the jaw joint, including temporomandibular joint syndrome and craniomandibular disorders; and treatment of conditions of the joint linking the jaw bone and skull and of the complex of muscles, nerves, and other tissues related to that joint.  Treatment to restore tooth structure lost due to attrition, erosion, or abrasion.

Exclusions and Limitations. The Services listed in this “Exclusions and Limitations” section are either completely excluded from coverage or partially limited under this EOC. These exclusions and limitations apply to all Services that would otherwise be covered under this EOC and are in addition to the exclusions and limitations that apply only to a particular Service as listed in the description of that Service in this EOC. Exclusions  Additional fees a Non-Participating Provider may charge for an Emergency Dental Care or Urgent Dental Care visit after our payment for covered Services. Continuation of Services performed or started prior to your coverage becoming effective. Continuation of Services performed or started after your membership terminates. Cosmetic Services, supplies, or prescription drugs that are intended primarily to improve appearance, repair, and/or replace cosmetic dental restorations.  Dental conditions for which Service or reimbursement is required by law to be provided at or by a government agency.  We do not reimburse the government agency for any Services that the law requires be provided only by or received only from a government agency. When we cover any of these Services, we may recover the Charges for the Services from the government agency. This exclusion does not apply to Medicaid. Dental implants, including bone augmentation and fixed or removable prosthetic devices attached to or covering the implants; all related Services, including diagnostic consultations, impressions, oral surgery, placement, removal, and cleaning when provided in conjunction with dental implants; and Services associated with postoperative conditions and complications arising from implants, unless your Group has purchased coverage for dental implants as an additional benefit.  Dental Services not listed in the “Benefits” sectionsection of this EOC.  Drugs obtainable with or without a prescription. These may be covered under your medical benefits.  Experimental or investigational treatments, procedures, and other Services that are not commonly considered standard dental practice or that require governmental U.S. Food and Drug Administration (FDA) approval.  A Service is experimental or investigational if: • the Service is not recognized in accordance with generally accepted dental standards as safe and effective for use in treating the condition in question, whether or not the Service is authorized by law for use in testing, or other studies on human patients: or • the Service requires approval by FDA authority prior to use and such approval has not been granted when the Service is to be rendered. Fees a provider may charge for an Emergency Dental Care or Urgent Dental Care visita missed appointment.  Full mouth reconstruction and reconstruction, including, but not limited to, occlusal rehabilitation, including appliances, restorations, and procedures needed to alter vertical dimension, occlusion, or correct attrition or abrasion.  Genetic testing.  “Hospital call fees,” “call fees” or similar Charges associated with Dentally Necessary Services that are performed at ambulatory surgical centers or hospitals.  Maxillofacial surgery. Medical or Hospital Services, unless otherwise specified in the EOC.  Missed appointment fees a provider may charge for a missed appointmentMyofunctional therapy.  Non-orthodontic recording of jaw movements or positions. Orthodontic Services, unless your Group has purchased orthodontic coverage as an additional benefit.  Orthodontic treatment of primary/transitional dentition. Orthognathic surgery. Procedures, appliances, or fixed crowns and bridges for periodontal splinting of teeth. Prosthetic devices following your decision to have extraction of a tooth (or of teeth) extracted for nonclinical reasons or when a tooth is restorable.  Replacement of lost or damaged space maintainers. Replacement of prefabricated, noncast crowns, including noncast stainless steel crowns that were not placed crowns, except when the Member has five or more years of continuous dental coverage with Company. Services performed by someone other than a Participating Provider or Non-Participating Provider.  Services for conditions that are covered by workers’ compensation or that are the employer’s responsibility.  Services furnished by a family member.  Services provided or arranged by criminal justice institutions for Members confined therein, unless care would be covered as Emergency Dental Care.  Speech aid prosthetic devices and follow up modifications.  Surgery to correct malocclusion or temporomandibular joint (TMJ) disorders; treatment for problems of the jaw joint, including temporomandibular joint (TMJ) syndrome and craniomandibular disorders; and treatment of conditions of the joint linking the jaw bone and skull and of the complex of muscles, nerves, and other tissues related to that joint.  Treatment of cleft palate. Treatment of macroglossia. Treatment of micrognathia. Treatment to restore tooth structure lost due to attrition, erosion, or abrasion. Use of alternative materials for the removal and replacement of clinically acceptable material or restorations is not covered for any reason, except when the pathological condition of the tooth (or teeth) warrants replacement.

Exclusions and Limitations. The Services listed in this “Exclusions and Limitations” section are either completely excluded from coverage or partially limited under this EOC. These exclusions and limitations apply to all Services that would otherwise be covered under this EOC and are in addition to the exclusions and limitations that apply only to a particular Service as listed in the description of that Service in this EOC. Exclusions  Cosmetic Services, supplies, or prescription drugs that are intended primarily to improve appearance, repair, and/or replace cosmetic dental restorations.  Dental conditions for which Service or reimbursement is required by law to be provided at or by a government agency.  Dental implants, including bone augmentation and fixed or removable prosthetic devices attached to or covering the implants; all related Services, including diagnostic consultations, impressions, oral surgery, placement, removal, and cleaning when provided in conjunction with dental implants; and Services associated with postoperative conditions and complications arising from implants, unless your Group has purchased coverage for dental implants as an additional benefit.  Dental Services not listed in the “Benefits” section.  Drugs obtainable with or without a prescription. These may be covered under your medical benefits.  Experimental or investigational treatments, procedures, and other Services that are not commonly considered standard dental practice or that require governmental approval.  Fees a provider may charge for an Emergency Dental Care or Urgent Dental Care visit.  Full mouth reconstruction and occlusal rehabilitation, including appliances, restorations, and procedures needed to alter vertical dimension, occlusion, or correct attrition or abrasion.  Genetic testing.  “Hospital call fees,” “call fees” or similar Charges associated with Dentally Necessary Services that are performed at ambulatory surgical centers or hospitals.  Medical or Hospital Services, unless otherwise specified in the EOC.  Missed appointment fees a provider may charge for a missed appointment.  Orthodontic Services, unless your Group has purchased orthodontic coverage as an additional benefit.  Prosthetic devices following your decision to have a tooth (or teeth) extracted for nonclinical reasons or when a tooth is restorable.  Replacement of prefabricated, noncast crowns, including noncast stainless steel crowns that were not placed by a Participating Provider.  Services for conditions that are covered by workers’ compensation or that are the employer’s responsibility.  Services furnished by a family member.  Services provided or arranged by criminal justice institutions for Members confined therein, unless care would be covered as Emergency Dental Care.  Speech aid prosthetic devices and follow up modifications.  Surgery to correct malocclusion or temporomandibular joint disorders; treatment for problems of the jaw joint, including temporomandibular joint syndrome and craniomandibular disorders; and treatment of conditions of the joint linking the jaw bone and skull and of the complex of muscles, nerves, and other tissues related to that joint.  Treatment to restore tooth structure lost due to attrition, erosion, or abrasion.

Exclusions and Limitations. The Services listed in this “Exclusions and Limitations” section are either completely excluded from coverage or partially limited under this EOC. These exclusions and limitations apply to all Services that would otherwise be covered under this EOC and are in addition to the exclusions and limitations that apply only to a particular Service as listed in the description of that Service in this EOC. Exclusions  Dental conditions for which Service or reimbursement is required by law to be provided at or by a government agency. Cosmetic Services, supplies, or prescription drugs that are intended primarily to improve appearance, repair, and/or replace cosmetic dental restorations.  Dental conditions for which Service or reimbursement is required by law to be provided at or by a government agency.  Dental implants, including bone augmentation and fixed or removable prosthetic devices attached to or covering the implants; all related Services, including diagnostic consultations, impressions, oral surgery, placement, removal, and cleaning when provided in conjunction with dental implants; and Services associated with postoperative conditions and complications arising from implants, unless your Group has purchased coverage for dental implants as an additional benefit.  Dental Services not listed in the “Benefits” section.  Drugs obtainable with or without a prescription. These may be covered under your medical benefits.  Experimental or investigational treatments, procedures, and other Services that are not commonly considered standard dental practice or that require governmental approval.  Fees a provider may charge for an Emergency Dental Care or Urgent Dental Care visit.  Full mouth reconstruction and occlusal rehabilitation, including appliances, restorations, and procedures needed to alter vertical dimension, occlusion, or correct attrition or abrasion.  Genetic testing.  “Hospital call fees,” “call fees” or similar Charges associated with Dentally Necessary Services that are performed at ambulatory surgical centers or hospitals.  Medical or Hospital Services, unless otherwise specified in the EOC.  Missed appointment fees a provider may charge for a missed appointment.  Orthodontic Services, unless your Group has purchased orthodontic coverage as an additional benefit.  Prosthetic devices following your decision to have a tooth (or teeth) extracted for nonclinical reasons or when a tooth is restorable.  Replacement of prefabricated, noncast crowns, including noncast stainless steel crowns that were not placed by a Participating Provider.  Services for conditions that are covered by workers’ compensation or that are the employer’s responsibility.  Services furnished by a family member.  Services provided or arranged by criminal justice institutions for Members confined therein, unless care would be covered as Emergency Dental Care.  Speech aid prosthetic devices and follow up modifications.  Surgery to correct malocclusion or temporomandibular joint disorders; treatment for problems of the jaw joint, including temporomandibular joint syndrome and craniomandibular disorders; and treatment of conditions of the joint linking the jaw bone and skull and of the complex of muscles, nerves, and other tissues related to that joint.  Treatment to restore tooth structure lost due to attrition, erosion, or abrasion.