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CHARGES FOR THE FOLLOWING SERVICES ARE EXCLUDED FROM THE PLAN

Conditions which are compensable under Workmen's Compensation or Employer's Liability Laws.

Services provided by any Federal, State or Provincial government agency, or are provided, without cost to the patient, by any municipality, county, or other political subdivision or community agency.

Accidental injuries including automobile accidents, except for services covered under Personal Liability or Automobile Personal Injury provisions.

Dental services started prior to the date the covered individual became eligible for such services.

Dental Services for which the covered individual would have no obligation to pay in the absence of this coverage.

Procedures, appliances or restoration to correct developmental, congenital, or medically induced disorders including, but not limited to, treatment of myofunctional, myoskeletal, temporomandibular joint dysfunction or changes in vertical dimension. Dental procedures performed in a hospital, including charges for hospital visits.

Malignancies and cysts * Prescription drugs * Speech  + +3m..  + +0mELTA_~1GIF + +usions.html<xpyTEXTOSSuXEEXCLUS~1HTMpimagesV xphJ y uXuZIMAGES psalary-daeo.gifxpy GIFfBlWdA鷖ASALARY~1GIFpsalary-dcta.gifxpy GIFfBlWd朷ALARY~2GIFpsalary-text.gifLxp y GIFfBlWdP> Prosthetic appliances for the replacement of the same natural teeth are a benefit only once in a five (S) year period. Replacement of an existing denture is a benefit only if it is unsatisfactory and cannot be made satisfactory.

Partial dentures will not be replaced within any five (5) year period unless necessary due to natural tooth loss where the addition or replacement of teeth to the existing partial is not feasible.

Fixed bridges are not covered on posterior teeth when abutment teeth are dentally sound, and would be crowned only for the purpose of supporting a poetic. A fixed bridge used under these circumstances is considered optional, and a patient is responsible for the difference in cost between the fixed bridge and the partial denture.

A removal partial denture is considered an adequate restoration of a case when teeth on both sides of a dental arch are missing. If the patient selects another course of treatment, the patient is responsible for the difference in cost between the optional treatment and a partial denture.

Removal cast partial dentures are not a benefit for patients under the age of sixteen (16).

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NAVIGATION

Introduction | Welcome | Plan Requirements | Co-Ordination of Benefits | Patient Charges | Exclusions | Dental Offices and Codes


Denver Public Schools
Employee Benefits Department
900 Grant Street, Room 502
Denver, Colorado 80203
(303) 764-3371