Please note your individual Dental Service Agreement for your specific benefits and limitations. The information provided below is of a general nature to assist persons with understanding the general scope of this program.What are co-payments?Co-payments are reduced fees that you pay directly to the dentist for some dental treatments. A partial list of some frequently used dental treatments is included in this site under SAMPLE CO-PAYMENTS. This list shows you the potential savings with Assurant Employee Benefits versus what you would pay without this Plan. Click below to view sample co-payments.
Cosmetic dentistryAssurant Employee Benefits understands the importance of your appearance. That's why we have included cosmetic services, such as bleaching and bonding procedures, in your plan benefits.
Orthodontic benefitsThe Secure Choice Plan includes reduced fees on Orthodontic procedures for children and adults. Plan Orthodontists provide reduced fees of 25% off his/her normal retail charge. Orthodontic services are available only in areas where Assurant Employee Benefits has Plan Orthodontist(s) who provide those services. Orthodontic treatment begun prior to your plan effective date is not eligible for this benefit.
Specialist benefitsShould the services of a specialist (oral surgeon, endodontist, orthodontist, periodontist, or pedodontist) be necessary, you may seek treatment from any Plan Specialist listed in our printed or online directory. If an oral surgeon, orthodontist, periodontist or pedodontist provides treatment, you will receive 25% off that specialist's normal retail charges. For treatment by an endodontist, you will receive 15% off that specialist's normal retail charges. Specialist services are available only in areas where Assurant Employee Benefits has Plan Specialist(s). Please note that payment for a service performed by a Non-Plan Specialist is your responsibility.
How do I join?Step 1: Select a dentist from the Plan Dentist Directory or online (choose the Heritage Series).
Step 2: Print the enrollment form by clicking at the print enrollment form notice below. Complete the enrollment form by being sure to include the Dental Facility Number of each dentist you have selected in the space provided.
Step 3: Choose your payment option. If you choose the annual prepayment fee, include the appropriate prepayment fee and the $35 enrollment fee with the completed enrollment form. Your check should be made payable to Assurant Employee Benefits.
Step 4: Mail to Phelps Financial Services, Inc., 659 Park Meadow Rd., Suite H, Westerville, Ohio 43081.
If you choose the automatic monthly bank draft, complete the Authorization Agreement included in this site under "Enrollment form," include a voided check, the first month's prepayment fee, and the $35 enrollment fee with the completed Enrollment form. Your check should be made payable to Assurant Employee Benefits. Please mail all to Phelps Financial Services, Inc. for processing. Monthly prepayment fees will thereafter be drawn automatically from your bank account.
While we accept automatic bank drafts from checking or savings accounts, we cannot accept personal checks on a monthly basis.
When will I receive a membership card?Once your application has been processed, you will receive a membership card, the Individual Dental Service Agreement, and a complete list of co-payments. Your effective date will be provided with your membership materials.
What if I need to change my dentist?You may change dentists by simply calling Customer Service at 800-443-2995.
How do I receive care?After your effective date, phone the dentist you selected and tell the office that you have Assurant Employee Benefits' prepaid coverage. They will schedule your appointment to see the dentist.
Who is eligible?You, your spouse and dependent children as defined by state law.
When do I renew my dental plan?If you select the annual prepayment method, a renewal notification and billing statement will be mailed to your home in advance of your anniversary date. If you select the monthly bank draft method for payment, no action is required to renew your dental plan.
Limitations and exclusions *1. Any services not specifically described in the Co-payment Schedule (including but not limited to any hospital or outpatient care facility cost associated with any dental service).
2. Any dental service initiated (a) before the effective date of Member’s enrollment or (b) after Member’s enrollment ends.
3. Services provided by Non-Plan Providers, unless for Emergency Services for temporary pain relief (with limited benefits), as specifically provided in the EMERGENCY SERVICES Article of the Individual Dental Service Agreement.
4. Replacement of bridgework, dentures or other fixed or removable appliances unless (a) at least five years have elapsed since such appliance was provided as a Plan Benefit, or (b) during that five year period, appliance becomes unusable and cannot be made usable due to Member’s illness or an accident involving damage to the appliance while it is in use.
5. Replacement of dentures or other removable appliances due to (a) damage while not in use or (b) loss or theft.
6. Oral reconstruction using fixed bridgework or other fixed appliances if the overall treatment plan to achieve complete oral reconstruction involves the replacement of six or more teeth (whether those teeth are missing before treatment begins or are extracted as part of the overall treatment plan).
7. Implants or any related implant appliances, or surgery for the insertion of implants or any related implant appliances, whether fixed or removable.
8. Surgical removal of implants or implant appliances, or any surgical or non-surgical services to adjust, repair, replace, or treat any problem related to an existing implant or implant appliance, whether fixed or removable.
9. Restorations or splints used to increase vertical dimension, restore occlusion, or replace or stabilize tooth structure lost by attrition.
10. Orthodontic treatment involving therapy for myofunctional problems, TMJ (temporomandibular joint) dysfunctions, micrognathia, macroglossia, cleft palate or other growth and developmental abnormalities.
11. Orthodontic treatment associated with orthognathic surgery, whether the treatment precedes or follows the surgery.
12. Extractions of third molars (wisdom teeth) that are not symptomatic, whether or not the extractions follow the completion of orthodontic treatment. Examples of symptomatic conditions include decay, odontogenic cysts, chronic pericoronitis and infection.
13. Treatment of malignancies, neoplasms or cysts, including but not limited to biopsies.
* FOR A COMPLETE EXPLANINATION OF COVERAGE AND LIMITATIONS, PLEASE READ YOUR STATE SPECIFIC POLICY. THE ABOVE IS GIVEN As A BRIEF OUTLINE AND IS NOT DESIGNED TO BE A COMPLETE LISTING OF THE POLICY BENEFITS AND LIMITATIONS.
Co-payments are reduced fees that you pay directly to the dentist for some dental treatments. A partial list of some frequently used dental treatments is included in this site under SAMPLE CO-PAYMENTS. This list shows you the potential savings with Assurant Employee Benefits versus what you would pay without this Plan. Click below to view sample co-payments.
Cosmetic dentistryAssurant Employee Benefits understands the importance of your appearance. That's why we have included cosmetic services, such as bleaching and bonding procedures, in your plan benefits.
Orthodontic benefitsThe Secure Choice Plan includes reduced fees on Orthodontic procedures for children and adults. Plan Orthodontists provide reduced fees of 25% off his/her normal retail charge. Orthodontic services are available only in areas where Assurant Employee Benefits has Plan Orthodontist(s) who provide those services. Orthodontic treatment begun prior to your plan effective date is not eligible for this benefit.
Specialist benefitsShould the services of a specialist (oral surgeon, endodontist, orthodontist, periodontist, or pedodontist) be necessary, you may seek treatment from any Plan Specialist listed in our printed or online directory. If an oral surgeon, orthodontist, periodontist or pedodontist provides treatment, you will receive 25% off that specialist's normal retail charges. For treatment by an endodontist, you will receive 15% off that specialist's normal retail charges. Specialist services are available only in areas where Assurant Employee Benefits has Plan Specialist(s). Please note that payment for a service performed by a Non-Plan Specialist is your responsibility.
How do I join?Step 1: Select a dentist from the Plan Dentist Directory or online (choose the Heritage Series).
Step 2: Print the enrollment form by clicking at the print enrollment form notice below. Complete the enrollment form by being sure to include the Dental Facility Number of each dentist you have selected in the space provided.
Step 3: Choose your payment option. If you choose the annual prepayment fee, include the appropriate prepayment fee and the $35 enrollment fee with the completed enrollment form. Your check should be made payable to Assurant Employee Benefits.
Step 4: Mail to Phelps Financial Services, Inc., 659 Park Meadow Rd., Suite H, Westerville, Ohio 43081.
If you choose the automatic monthly bank draft, complete the Authorization Agreement included in this site under "Enrollment form," include a voided check, the first month's prepayment fee, and the $35 enrollment fee with the completed Enrollment form. Your check should be made payable to Assurant Employee Benefits. Please mail all to Phelps Financial Services, Inc. for processing. Monthly prepayment fees will thereafter be drawn automatically from your bank account.
While we accept automatic bank drafts from checking or savings accounts, we cannot accept personal checks on a monthly basis.
When will I receive a membership card?Once your application has been processed, you will receive a membership card, the Individual Dental Service Agreement, and a complete list of co-payments. Your effective date will be provided with your membership materials.
What if I need to change my dentist?You may change dentists by simply calling Customer Service at 800-443-2995.
How do I receive care?After your effective date, phone the dentist you selected and tell the office that you have Assurant Employee Benefits' prepaid coverage. They will schedule your appointment to see the dentist.
Who is eligible?You, your spouse and dependent children as defined by state law.
When do I renew my dental plan?If you select the annual prepayment method, a renewal notification and billing statement will be mailed to your home in advance of your anniversary date. If you select the monthly bank draft method for payment, no action is required to renew your dental plan.
Limitations and exclusions *1. Any services not specifically described in the Co-payment Schedule (including but not limited to any hospital or outpatient care facility cost associated with any dental service).
2. Any dental service initiated (a) before the effective date of Member’s enrollment or (b) after Member’s enrollment ends.
3. Services provided by Non-Plan Providers, unless for Emergency Services for temporary pain relief (with limited benefits), as specifically provided in the EMERGENCY SERVICES Article of the Individual Dental Service Agreement.
4. Replacement of bridgework, dentures or other fixed or removable appliances unless (a) at least five years have elapsed since such appliance was provided as a Plan Benefit, or (b) during that five year period, appliance becomes unusable and cannot be made usable due to Member’s illness or an accident involving damage to the appliance while it is in use.
5. Replacement of dentures or other removable appliances due to (a) damage while not in use or (b) loss or theft.
6. Oral reconstruction using fixed bridgework or other fixed appliances if the overall treatment plan to achieve complete oral reconstruction involves the replacement of six or more teeth (whether those teeth are missing before treatment begins or are extracted as part of the overall treatment plan).
7. Implants or any related implant appliances, or surgery for the insertion of implants or any related implant appliances, whether fixed or removable.
8. Surgical removal of implants or implant appliances, or any surgical or non-surgical services to adjust, repair, replace, or treat any problem related to an existing implant or implant appliance, whether fixed or removable.
9. Restorations or splints used to increase vertical dimension, restore occlusion, or replace or stabilize tooth structure lost by attrition.
10. Orthodontic treatment involving therapy for myofunctional problems, TMJ (temporomandibular joint) dysfunctions, micrognathia, macroglossia, cleft palate or other growth and developmental abnormalities.
11. Orthodontic treatment associated with orthognathic surgery, whether the treatment precedes or follows the surgery.
12. Extractions of third molars (wisdom teeth) that are not symptomatic, whether or not the extractions follow the completion of orthodontic treatment. Examples of symptomatic conditions include decay, odontogenic cysts, chronic pericoronitis and infection.
13. Treatment of malignancies, neoplasms or cysts, including but not limited to biopsies.
* FOR A COMPLETE EXPLANINATION OF COVERAGE AND LIMITATIONS, PLEASE READ YOUR STATE SPECIFIC POLICY. THE ABOVE IS GIVEN As A BRIEF OUTLINE AND IS NOT DESIGNED TO BE A COMPLETE LISTING OF THE POLICY BENEFITS AND LIMITATIONS.
The Secure Choice Plan includes reduced fees on Orthodontic procedures for children and adults. Plan Orthodontists provide reduced fees of 25% off his/her normal retail charge. Orthodontic services are available only in areas where Assurant Employee Benefits has Plan Orthodontist(s) who provide those services. Orthodontic treatment begun prior to your plan effective date is not eligible for this benefit.
Specialist benefitsShould the services of a specialist (oral surgeon, endodontist, orthodontist, periodontist, or pedodontist) be necessary, you may seek treatment from any Plan Specialist listed in our printed or online directory. If an oral surgeon, orthodontist, periodontist or pedodontist provides treatment, you will receive 25% off that specialist's normal retail charges. For treatment by an endodontist, you will receive 15% off that specialist's normal retail charges. Specialist services are available only in areas where Assurant Employee Benefits has Plan Specialist(s). Please note that payment for a service performed by a Non-Plan Specialist is your responsibility.
How do I join?Step 1: Select a dentist from the Plan Dentist Directory or online (choose the Heritage Series).
Step 2: Print the enrollment form by clicking at the print enrollment form notice below. Complete the enrollment form by being sure to include the Dental Facility Number of each dentist you have selected in the space provided.
Step 3: Choose your payment option. If you choose the annual prepayment fee, include the appropriate prepayment fee and the $35 enrollment fee with the completed enrollment form. Your check should be made payable to Assurant Employee Benefits.
Step 4: Mail to Phelps Financial Services, Inc., 659 Park Meadow Rd., Suite H, Westerville, Ohio 43081.
If you choose the automatic monthly bank draft, complete the Authorization Agreement included in this site under "Enrollment form," include a voided check, the first month's prepayment fee, and the $35 enrollment fee with the completed Enrollment form. Your check should be made payable to Assurant Employee Benefits. Please mail all to Phelps Financial Services, Inc. for processing. Monthly prepayment fees will thereafter be drawn automatically from your bank account.
While we accept automatic bank drafts from checking or savings accounts, we cannot accept personal checks on a monthly basis.
When will I receive a membership card?Once your application has been processed, you will receive a membership card, the Individual Dental Service Agreement, and a complete list of co-payments. Your effective date will be provided with your membership materials.
What if I need to change my dentist?You may change dentists by simply calling Customer Service at 800-443-2995.
How do I receive care?After your effective date, phone the dentist you selected and tell the office that you have Assurant Employee Benefits' prepaid coverage. They will schedule your appointment to see the dentist.
Who is eligible?You, your spouse and dependent children as defined by state law.
When do I renew my dental plan?If you select the annual prepayment method, a renewal notification and billing statement will be mailed to your home in advance of your anniversary date. If you select the monthly bank draft method for payment, no action is required to renew your dental plan.
Limitations and exclusions *1. Any services not specifically described in the Co-payment Schedule (including but not limited to any hospital or outpatient care facility cost associated with any dental service).
2. Any dental service initiated (a) before the effective date of Member’s enrollment or (b) after Member’s enrollment ends.
3. Services provided by Non-Plan Providers, unless for Emergency Services for temporary pain relief (with limited benefits), as specifically provided in the EMERGENCY SERVICES Article of the Individual Dental Service Agreement.
4. Replacement of bridgework, dentures or other fixed or removable appliances unless (a) at least five years have elapsed since such appliance was provided as a Plan Benefit, or (b) during that five year period, appliance becomes unusable and cannot be made usable due to Member’s illness or an accident involving damage to the appliance while it is in use.
5. Replacement of dentures or other removable appliances due to (a) damage while not in use or (b) loss or theft.
6. Oral reconstruction using fixed bridgework or other fixed appliances if the overall treatment plan to achieve complete oral reconstruction involves the replacement of six or more teeth (whether those teeth are missing before treatment begins or are extracted as part of the overall treatment plan).
7. Implants or any related implant appliances, or surgery for the insertion of implants or any related implant appliances, whether fixed or removable.
8. Surgical removal of implants or implant appliances, or any surgical or non-surgical services to adjust, repair, replace, or treat any problem related to an existing implant or implant appliance, whether fixed or removable.
9. Restorations or splints used to increase vertical dimension, restore occlusion, or replace or stabilize tooth structure lost by attrition.
10. Orthodontic treatment involving therapy for myofunctional problems, TMJ (temporomandibular joint) dysfunctions, micrognathia, macroglossia, cleft palate or other growth and developmental abnormalities.
11. Orthodontic treatment associated with orthognathic surgery, whether the treatment precedes or follows the surgery.
12. Extractions of third molars (wisdom teeth) that are not symptomatic, whether or not the extractions follow the completion of orthodontic treatment. Examples of symptomatic conditions include decay, odontogenic cysts, chronic pericoronitis and infection.
13. Treatment of malignancies, neoplasms or cysts, including but not limited to biopsies.
* FOR A COMPLETE EXPLANINATION OF COVERAGE AND LIMITATIONS, PLEASE READ YOUR STATE SPECIFIC POLICY. THE ABOVE IS GIVEN As A BRIEF OUTLINE AND IS NOT DESIGNED TO BE A COMPLETE LISTING OF THE POLICY BENEFITS AND LIMITATIONS.
Step 1: Select a dentist from the Plan Dentist Directory or online (choose the Heritage Series).
Step 2: Print the enrollment form by clicking at the print enrollment form notice below. Complete the enrollment form by being sure to include the Dental Facility Number of each dentist you have selected in the space provided.
Step 3: Choose your payment option. If you choose the annual prepayment fee, include the appropriate prepayment fee and the $35 enrollment fee with the completed enrollment form. Your check should be made payable to Assurant Employee Benefits.
Step 4: Mail to Phelps Financial Services, Inc., 659 Park Meadow Rd., Suite H, Westerville, Ohio 43081.
If you choose the automatic monthly bank draft, complete the Authorization Agreement included in this site under "Enrollment form," include a voided check, the first month's prepayment fee, and the $35 enrollment fee with the completed Enrollment form. Your check should be made payable to Assurant Employee Benefits. Please mail all to Phelps Financial Services, Inc. for processing. Monthly prepayment fees will thereafter be drawn automatically from your bank account.
While we accept automatic bank drafts from checking or savings accounts, we cannot accept personal checks on a monthly basis.
When will I receive a membership card?Once your application has been processed, you will receive a membership card, the Individual Dental Service Agreement, and a complete list of co-payments. Your effective date will be provided with your membership materials.
What if I need to change my dentist?You may change dentists by simply calling Customer Service at 800-443-2995.
How do I receive care?After your effective date, phone the dentist you selected and tell the office that you have Assurant Employee Benefits' prepaid coverage. They will schedule your appointment to see the dentist.
Who is eligible?You, your spouse and dependent children as defined by state law.
When do I renew my dental plan?If you select the annual prepayment method, a renewal notification and billing statement will be mailed to your home in advance of your anniversary date. If you select the monthly bank draft method for payment, no action is required to renew your dental plan.
Limitations and exclusions *1. Any services not specifically described in the Co-payment Schedule (including but not limited to any hospital or outpatient care facility cost associated with any dental service).
2. Any dental service initiated (a) before the effective date of Member’s enrollment or (b) after Member’s enrollment ends.
3. Services provided by Non-Plan Providers, unless for Emergency Services for temporary pain relief (with limited benefits), as specifically provided in the EMERGENCY SERVICES Article of the Individual Dental Service Agreement.
4. Replacement of bridgework, dentures or other fixed or removable appliances unless (a) at least five years have elapsed since such appliance was provided as a Plan Benefit, or (b) during that five year period, appliance becomes unusable and cannot be made usable due to Member’s illness or an accident involving damage to the appliance while it is in use.
5. Replacement of dentures or other removable appliances due to (a) damage while not in use or (b) loss or theft.
6. Oral reconstruction using fixed bridgework or other fixed appliances if the overall treatment plan to achieve complete oral reconstruction involves the replacement of six or more teeth (whether those teeth are missing before treatment begins or are extracted as part of the overall treatment plan).
7. Implants or any related implant appliances, or surgery for the insertion of implants or any related implant appliances, whether fixed or removable.
8. Surgical removal of implants or implant appliances, or any surgical or non-surgical services to adjust, repair, replace, or treat any problem related to an existing implant or implant appliance, whether fixed or removable.
9. Restorations or splints used to increase vertical dimension, restore occlusion, or replace or stabilize tooth structure lost by attrition.
10. Orthodontic treatment involving therapy for myofunctional problems, TMJ (temporomandibular joint) dysfunctions, micrognathia, macroglossia, cleft palate or other growth and developmental abnormalities.
11. Orthodontic treatment associated with orthognathic surgery, whether the treatment precedes or follows the surgery.
12. Extractions of third molars (wisdom teeth) that are not symptomatic, whether or not the extractions follow the completion of orthodontic treatment. Examples of symptomatic conditions include decay, odontogenic cysts, chronic pericoronitis and infection.
13. Treatment of malignancies, neoplasms or cysts, including but not limited to biopsies.
* FOR A COMPLETE EXPLANINATION OF COVERAGE AND LIMITATIONS, PLEASE READ YOUR STATE SPECIFIC POLICY. THE ABOVE IS GIVEN As A BRIEF OUTLINE AND IS NOT DESIGNED TO BE A COMPLETE LISTING OF THE POLICY BENEFITS AND LIMITATIONS.
You may change dentists by simply calling Customer Service at 800-443-2995.
How do I receive care?After your effective date, phone the dentist you selected and tell the office that you have Assurant Employee Benefits' prepaid coverage. They will schedule your appointment to see the dentist.
Who is eligible?You, your spouse and dependent children as defined by state law.
When do I renew my dental plan?If you select the annual prepayment method, a renewal notification and billing statement will be mailed to your home in advance of your anniversary date. If you select the monthly bank draft method for payment, no action is required to renew your dental plan.
Limitations and exclusions *1. Any services not specifically described in the Co-payment Schedule (including but not limited to any hospital or outpatient care facility cost associated with any dental service).
2. Any dental service initiated (a) before the effective date of Member’s enrollment or (b) after Member’s enrollment ends.
3. Services provided by Non-Plan Providers, unless for Emergency Services for temporary pain relief (with limited benefits), as specifically provided in the EMERGENCY SERVICES Article of the Individual Dental Service Agreement.
4. Replacement of bridgework, dentures or other fixed or removable appliances unless (a) at least five years have elapsed since such appliance was provided as a Plan Benefit, or (b) during that five year period, appliance becomes unusable and cannot be made usable due to Member’s illness or an accident involving damage to the appliance while it is in use.
5. Replacement of dentures or other removable appliances due to (a) damage while not in use or (b) loss or theft.
6. Oral reconstruction using fixed bridgework or other fixed appliances if the overall treatment plan to achieve complete oral reconstruction involves the replacement of six or more teeth (whether those teeth are missing before treatment begins or are extracted as part of the overall treatment plan).
7. Implants or any related implant appliances, or surgery for the insertion of implants or any related implant appliances, whether fixed or removable.
8. Surgical removal of implants or implant appliances, or any surgical or non-surgical services to adjust, repair, replace, or treat any problem related to an existing implant or implant appliance, whether fixed or removable.
9. Restorations or splints used to increase vertical dimension, restore occlusion, or replace or stabilize tooth structure lost by attrition.
10. Orthodontic treatment involving therapy for myofunctional problems, TMJ (temporomandibular joint) dysfunctions, micrognathia, macroglossia, cleft palate or other growth and developmental abnormalities.
11. Orthodontic treatment associated with orthognathic surgery, whether the treatment precedes or follows the surgery.
12. Extractions of third molars (wisdom teeth) that are not symptomatic, whether or not the extractions follow the completion of orthodontic treatment. Examples of symptomatic conditions include decay, odontogenic cysts, chronic pericoronitis and infection.
13. Treatment of malignancies, neoplasms or cysts, including but not limited to biopsies.
* FOR A COMPLETE EXPLANINATION OF COVERAGE AND LIMITATIONS, PLEASE READ YOUR STATE SPECIFIC POLICY. THE ABOVE IS GIVEN As A BRIEF OUTLINE AND IS NOT DESIGNED TO BE A COMPLETE LISTING OF THE POLICY BENEFITS AND LIMITATIONS.
You, your spouse and dependent children as defined by state law.
When do I renew my dental plan?If you select the annual prepayment method, a renewal notification and billing statement will be mailed to your home in advance of your anniversary date. If you select the monthly bank draft method for payment, no action is required to renew your dental plan.
Limitations and exclusions *1. Any services not specifically described in the Co-payment Schedule (including but not limited to any hospital or outpatient care facility cost associated with any dental service).
2. Any dental service initiated (a) before the effective date of Member’s enrollment or (b) after Member’s enrollment ends.
3. Services provided by Non-Plan Providers, unless for Emergency Services for temporary pain relief (with limited benefits), as specifically provided in the EMERGENCY SERVICES Article of the Individual Dental Service Agreement.
4. Replacement of bridgework, dentures or other fixed or removable appliances unless (a) at least five years have elapsed since such appliance was provided as a Plan Benefit, or (b) during that five year period, appliance becomes unusable and cannot be made usable due to Member’s illness or an accident involving damage to the appliance while it is in use.
5. Replacement of dentures or other removable appliances due to (a) damage while not in use or (b) loss or theft.
6. Oral reconstruction using fixed bridgework or other fixed appliances if the overall treatment plan to achieve complete oral reconstruction involves the replacement of six or more teeth (whether those teeth are missing before treatment begins or are extracted as part of the overall treatment plan).
7. Implants or any related implant appliances, or surgery for the insertion of implants or any related implant appliances, whether fixed or removable.
8. Surgical removal of implants or implant appliances, or any surgical or non-surgical services to adjust, repair, replace, or treat any problem related to an existing implant or implant appliance, whether fixed or removable.
9. Restorations or splints used to increase vertical dimension, restore occlusion, or replace or stabilize tooth structure lost by attrition.
10. Orthodontic treatment involving therapy for myofunctional problems, TMJ (temporomandibular joint) dysfunctions, micrognathia, macroglossia, cleft palate or other growth and developmental abnormalities.
11. Orthodontic treatment associated with orthognathic surgery, whether the treatment precedes or follows the surgery.
12. Extractions of third molars (wisdom teeth) that are not symptomatic, whether or not the extractions follow the completion of orthodontic treatment. Examples of symptomatic conditions include decay, odontogenic cysts, chronic pericoronitis and infection.
13. Treatment of malignancies, neoplasms or cysts, including but not limited to biopsies.
* FOR A COMPLETE EXPLANINATION OF COVERAGE AND LIMITATIONS, PLEASE READ YOUR STATE SPECIFIC POLICY. THE ABOVE IS GIVEN As A BRIEF OUTLINE AND IS NOT DESIGNED TO BE A COMPLETE LISTING OF THE POLICY BENEFITS AND LIMITATIONS.
1. Any services not specifically described in the Co-payment Schedule (including but not limited to any hospital or outpatient care facility cost associated with any dental service).
2. Any dental service initiated (a) before the effective date of Member’s enrollment or (b) after Member’s enrollment ends.
3. Services provided by Non-Plan Providers, unless for Emergency Services for temporary pain relief (with limited benefits), as specifically provided in the EMERGENCY SERVICES Article of the Individual Dental Service Agreement.
4. Replacement of bridgework, dentures or other fixed or removable appliances unless (a) at least five years have elapsed since such appliance was provided as a Plan Benefit, or (b) during that five year period, appliance becomes unusable and cannot be made usable due to Member’s illness or an accident involving damage to the appliance while it is in use.
5. Replacement of dentures or other removable appliances due to (a) damage while not in use or (b) loss or theft.
6. Oral reconstruction using fixed bridgework or other fixed appliances if the overall treatment plan to achieve complete oral reconstruction involves the replacement of six or more teeth (whether those teeth are missing before treatment begins or are extracted as part of the overall treatment plan).
7. Implants or any related implant appliances, or surgery for the insertion of implants or any related implant appliances, whether fixed or removable.
8. Surgical removal of implants or implant appliances, or any surgical or non-surgical services to adjust, repair, replace, or treat any problem related to an existing implant or implant appliance, whether fixed or removable.
9. Restorations or splints used to increase vertical dimension, restore occlusion, or replace or stabilize tooth structure lost by attrition.
10. Orthodontic treatment involving therapy for myofunctional problems, TMJ (temporomandibular joint) dysfunctions, micrognathia, macroglossia, cleft palate or other growth and developmental abnormalities.
11. Orthodontic treatment associated with orthognathic surgery, whether the treatment precedes or follows the surgery.
12. Extractions of third molars (wisdom teeth) that are not symptomatic, whether or not the extractions follow the completion of orthodontic treatment. Examples of symptomatic conditions include decay, odontogenic cysts, chronic pericoronitis and infection.
13. Treatment of malignancies, neoplasms or cysts, including but not limited to biopsies.
* FOR A COMPLETE EXPLANINATION OF COVERAGE AND LIMITATIONS, PLEASE READ YOUR STATE SPECIFIC POLICY. THE ABOVE IS GIVEN As A BRIEF OUTLINE AND IS NOT DESIGNED TO BE A COMPLETE LISTING OF THE POLICY BENEFITS AND LIMITATIONS.