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Exclusions (Expenses Not Covered By The Plan)
  • Treatment or appliances, related directly or indirectly to full mouth reconstruction, or to correct vertical dimension and temporal mandibular joint dysfunction.
  • Services rendered by a dental hygienist but not administered under the supervision of a dentist except in provinces where it is permitted.
  • Services that are not medically required, treatment rendered mainly for cosmetic purposes or that is experimental in nature.
  • Services and supplies relating to any appliance worn in the practice of a sport including mouth guards.
  • Treatment furnished without charge or paid for directly or indirectly by any government or for which a government prohibits payment.
  • Treatment received from a dental or medical department maintained, or paid for, directly or indirectly, by an employer, a mutual benefit association, or similar group.
  • Fixed bridgework which is in excess of the reasonable and customary charge that would have been made if the replacement of teeth could have been accomplished by a partial denture.
  • Expenses incurred for veneers or for oral hygiene instruction.
  • Splinting for periodontal reasons, where cast crowns or inlays are used for this purpose, with or without onlays
  • Expenses that are payable or reimburseable under a public or private plan or that would normally be so if a claim had been submitted.
  • Care or services rendered free of charge, or that would be if there were no benefit coverage or that are not chargeable to the partient.
  • Dental implants (except as specified on page 42).
  • Dental treatment resulting from war, engaging in a riot, civil unrest, or insurrection or intentional self-inflicted injury or suicide attempt.
  • Replacement of an existing appliance (e.g. fixed bridgework, removable partial or complete denture) unless:
    • the replacement is required because of the extraction of one or more natural teeth after the effective date of coverage, or
    • the existing appliance is at least five years old and cannot be made serviceable, or
    • the existing appliance is only temporary and is replaced with a permanent appliance while the coverage is in effect and within 12 months of installation of the temporary appliance, or
    • the replacement denture or bridgework is made necessary as the result of an initial placement of an opposing denture while covered, or
    • the replacement denture or bridgework is made necessary as the result of an accidental bodily injury while covered.
    • Charges for broken appointments or for completion of claim forms.
    • Services that exceed the ordinary services given in accordance with current therapeutic practice.
    • Charges resulting from a motor vehicle accident, or expenses that would be paid by workers compensation statute or other similar law.
    • Orthodontic treatment except for dependent children who are at least 6 years old but not yet 18 years of age.
    • Replacement of lost, mislaid, or stolen dentures.
    • Services or supplies received while not ordinarily resident in Canada.