Dental Health Insurance Exclusions
All dental insurance plans will have a specific list of treatments that will not receive benefits under your policy. These are referred to as the exclusions or limitations. A limitation usually refers to a maximum benefit limit on a specific covered dental health insurance benefit. The exclusions may differ between HMO dental plans, PPO dental plans and indemnity dental plans, but there are certain exclusions that you should expect to find in your dental insurance plan.
Dental Insurance Exclusions may include:
- Treatments received from a non-participating dentist
- Routine examinations within 6 months of your previous exam
- X-rays received within one year of your previous x-rays
- Any procedure not listed in the description of covered benefits
- Treatments that are paid for by a government agency or other dental insurance plan
- Dental injury caused as a result of war
- Dental treatments that were started prior to the purchase of your dental insurance plan
- Hospital charges or ambulance services
- Jaw fractures or disclocations
- General anesthesia
- Dental treatments caused by a birth defect or congenital malformation
- Replacement of lost dentures
- Treatment for disorders of the jaw
- Dietary analysis and treatments
- Treatment that is not dentally necessary
- Dental treatments, such as veneers, that are for cosmetic purposes only
- Orthodontics
When choosing a dental insurance plan, review the disclosed exclusions and limitations to make sure that they do not include services that are covered dental insurance benefits under most other plans. Also, if you are primarily looking for dental insurance to assist in payment of a specific service, such as orthodontics, make sure that this procedure is listed under covered benefits and not part of the dental insurance exclusions.
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