Charges Not Eligible For Dental Insurance

Payment will not be made for any dental procedure required due to an injury or dental disease for which you, or your Dependent, were advised to receive treatment or for which treatment first began before the effective date for that dental procedure.

The following items are not considered as covered expenses:

1. supplies or services which are not furnished by a legally qualified dentist or denturist acting within the scope of his license
2. replacement of a lost or stolen prosthetic device
3. charges for protective athletic appliances
4. services and supplies that are partially or wholly cosmetic in nature
5. services or supplies which are not medically necessary to the care and treatment of any existing or suspected injury or disease
6. charges for completion of claim forms, broken appointments, counselling, travel, communication costs or for advice by telephone
7. any dental examinations required by a third party
8. any charges which would not normally have been made but for the presence of this insurance or for which you or your Dependent are not obligated to pay
9. expenses incurred as a result of intentionally self-inflicted injuries (while sane or insane) or as a result of committing or attempting to commit a criminal offence
10. expenses for treatment required as a result of war, (declared or not) or participation in a riot, insurrection or civil commotion
11. expenses for services or treatment that are payable by Workplace Safety & Insurance Law (or Similar legislation) or any government plan, or which are received without charge or which a government health plan prohibits being paid
12. services or supplies for implantology, including tooth implantation, transplantation and surgical insertion of fabricated implants
13. services or supplies in connection with any procedures excluded as an eligible expense, such as crowns and bridgework
14. any Hospital charges for board and room and related services and supplies
15. dental treatment which is primarily experimental or for dietary planning, congenital or developmental malformation
16. any dental procedure required due to teeth extracted, missing or fractured before the effective date of your coverage for that procedure except as specifically stated for appliance replacement above.
17. Orthodontic services including the diagnosis, prevention management and correction of mal-relationships, irregularities and abnormalities of the teeth, jaw and face.
18. Charges which were considered an insured service of any provincial government plan at the time this plan/benefit was issued and subsequently were modified, suspended or discontinued