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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.
  • - Orthodontic treatment.
  • - Dental implants (except when otherwise noted).
  • - 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.
  • - Replacement of lost, mislaid, or stolen dentures.
  • - 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.
  • - Services or supplies received while not ordinarily resident in Canada.