Exclusions for Employers Dental Services (EDS)

(This is a Pre-Paid Dental Plan)

Comments that are bulleted and highlighted in Blue are observations by Savon

There is no coverage

1. Visits or services performed by a Dentist,Specialist or professional not contracted with Employers Dental Services except in connection with dental emergencies.
2. Any dental services which, in the judgment of the Dentist, are not reasonable and necessary for the prevention, correction or improvement of a condition which is subject to treatment by the practice of dentistry.
3. Programs or treatment, including prosthetics, which were in progress prior to the date any person became a member under this Plan.
4. Any dental services related to any sickness or injury arising out of, or in the course of any occupation or unemployment for remuneration or profit.  Also, any dental services for which the member is reimbursed, entitled to reimbursement, or is in any way indemnified for such expenses by, or through any public program, State, Federal or Local, or any program of medical benefits sponsored and paid for by the Federal Government, the State Government, any County or municipal government or any program of medical benefits sponsored and paid for by the Federal Government or any agency thereof.
5. Any dental service not specifically described in the Schedule of Benefits.
6. Any dental services, other than emergency dental services, which are related to accidents or accidental injury.
7. Any costs or expenses incurred in the event the member desires to be or is involuntarily hospitalized for any dental procedures or services, except in connection with dental emergencies.
8. Dispensing of drugs or any prescription drug charges incurred for treatment of oral disease except as may be specifically provided for in the Schedule of Benefits.
9. Any dental services, other than emergency dental services, which are necessitated as a result of intentionally self inflicted condition.
10. Oral surgery or extractions which are solely for orthodontic purposes or requiring the setting of fractures or dislocations, except as may be specifically provided for in the Schedule of Benefits.
    
    This is especially important for families with children ages 8 to 16 years old.
    
    
11. Treatment of malignancies, cysts, neoplasm or congenital defects.
12. Conditions affecting the temporomandibular joint (TMJ) including dysfunction and/or malocclusion except as may be specifically provided for in the Schedule of Benefits.
13. Any general anesthetic charges or services of an anesthetist or anesthesiologist.
14. Gold foil restoration.
15. Any dental services requiring, or pertaining to, cosmetic surgery for beautification, treatment of obesity and appliances or restoration necessary to increase vertical dimension or to restore an occlusion or to correct a congenital condition.
16. Any new services or procedures performed after the last day of the month during which any person ceased to be eligible for participation under the Plan.
17. If a member continually fails to follow a prescribed course of treatment, the treating EDS dentist may refuse to continue that course of treatment at anytime.