Exclusions

The following are excluded under United Concordia dental plans:

1. Any procedure not specifically listed as a covered benefit.
2. Dental Services, which are obtained outside of the office in which the member is enrolled and which, are not pre-authorized by United Concordia (including specialty services).
3. Services which in the opinion of the Dentist, or the Company are not clinically necessary, or do not have a reasonable, favorable prognosis.
4. Services or charges which are necessary due to lack of cooperation with the treating dentist, or failure to comply with a professionally prescribed Treatment Plan.  
5. Treatment that was started or incurred prior to the member's eligibility under United Concordia or after the Termination Date of coverage with United Concordia.
6. Consultation by a specialist for non-covered benefits.
7. Services or supplies that do not meet accepted standards of dental practice, which are experimental in nature or are considered enhancements to standard dental care.
8. Hospitalization costs (and associated fees) for any dental procedures.
9. United Concordia will not be financially responsible for services determined to be the responsibility or Worker's Compensation or Employer's Liability, services for which benefits are payable under any Federal Government or any state program, or for services for treatment of any automobile related injury in which the member is entitled to payment under an automobile insurance policy.
10. Prescriptions or non-prescriptions drugs, home care items, vitamins or dietary supplements.
11. Service or supplies that are cosmetic in nature, including, but not limited to:
    • Bleaching of teeth;
    • Veneer facings;
    • Personalization of crowns, bridges and/or dentures
12. For diagnostic services and treatment of jaw joint problems by any method.  These jaw joint problems include such conditions as temporomandibular joint (TMJ) and craniomandibular disorders or other conditions of the joint linking the jaw bone and the complex of muscles, nerves and other tissues related to that joint.
13. Services and/or appliances that alter the vertical dimension or alter, restore or maintain the occlusion, including, but not limited to, full mouth rehabilitation, splinting, appliances or any other method.
14. Services, supplies or charges that restore tooth structure lost due to attrition, erosion or abrasion.
15. Replacement of dentures, appliances, crowns, or bridgework, due to loss or theft or any duplicate prosthetic device or appliance.
16. The following are not included as orthodontic benefits: retreatment of orthodontic cases, changes in orthodontic treatment necessitated by patient non-cooperation, repair of orthodontic appliances, replacement of lost or stolen appliances, special appliances (including, but not limited to, headgear, orthopedic appliances, bite planes, functional appliances or palatal expanders), myofunctional therapy, cases involving orthognathic surgery, extractions for orthodontic purposes, and treatment in excess of 24 months.
17. Implants, surgical insertion and/or removal of, any and appliances and/or prosthetics attached to implants.
18. Required because of, or in connection with, acts of war, declared or undeclared.
19. Elective procedures, including, but not limited to, prophylactic extractions of third molars.