Services for injuries or conditions which are compensable under Worker's Compensation or Employer's Liability Laws.
Services which are provided by any governmental agency.
Services started prior to the date the covered person became eligible for such services.
Hospitalization, hospital visits, hospital anesthesia, and prescription drugs.
Charges for completion of forms, speech therapy, and the replacement of lost or stolen appliances.
Experimental treatment and services for which the prognosis is not good.
Charges for services for which the covered person would have no obligation to pay in the absence of this coverage.
Claims submitted more than twelve (12) months after the date of service.
Services Not Covered
Surgical correction of congenital or developmental acquired malformations, except intraoral dental services for the treatment of a condition which is related to or developed as a result of cleft lip or cleft palate or both.
Treatment for the disturbances of the temporomandibular joint.
Procedures necessary to alter or correct occlusion or vertical dimension, or restoration of tooth structure lost through attrition.
Associated sedative procedures (Relative Analgesia, Hypnosis, Pre-medication).
Treatment solely for cosmetic reasons.
Plaque control programs.
Coordination Of Benefits
If a covered individual is entitled to benefits under any other plan, as defined below, which will pay all or part of the expenses incurred for usual, reasonable and customary charges for dental services and supplies, the amount of dental expense benefits payable by this plan in combination with any other plan(s) will not exceed 100% of such usual, reasonable and customary expense incurred. In no event shall the Delta Dental Plan payment exceed the amount which would have been paid in the absence of other plan involvement.
The term "Plan" includes the benefits payable under this Plan and any other plan under which basic or prosthodontic or orthodontic dental benefits are provided by group, blanket or franchise coverage, service type plans or any other group payment plans, Blue Cross-Blue Shield Plans, labor-management trusteed plans, union welfare plans, coverage which is employer or employee required or provided by any statute, or coverage sponsored by or through a school or other educational institution, or No Fault automobile insurance.
When To Use Your Dental Care Plan
Routine dental care is the best way to maintain your oral health. Start at your earliest convenience and repeat your check-ups at least annually.
Delta shall make the statutorily required continuation coverage available to qualified beneficiaries of the School District in accordance with the Consolidated Omnibus Budget Reconciliation Act. Please contact the School District for details.