What is an Eligible Expense?
Expenses must be incurred while the Policy is in force and the person
is covered by the Policy. To be an Eligible Expense, the dental
services must be performed by: *A licensed Dentist acting within the
scope of his license; *A licensed Physician performing dental services
within the scope of his license; or *A licensed dental hygienist
acting under the supervision and direction of a Dentist.
When is an Eligible Expense considered
incurred?
An Eligible Expense is considered incurred on the following dates:
*For full and partial dentures - on the date the final impression is
taken. *For fixed bridges, crowns, inlays and onlays - on the date the
teeth are first prepared. *For root canal therapy - on the date the
pulp chamber is opened. *For periodontal surgery - on the day surgery
is performed. *For all other services - on the date the service is
performed.
What services are not covered?
- These services are not covered by Competitor
Smile Dental:
- Overdentures and associated procedures
- Replacement of full and partial dentures,
bridges, inlays, onlays or crowns that can be repaired or restored
to normal function
- Replacement of lost or stolen appliances,
orthodontic retainers, athletic mouth guards, precision or
semi-precision attachments, denture duplication, or for sealants
- Hygiene instructions, plaque control, acid
etch, broken appointments, prescription or take-home fluoride or
diagnostic photographs
- Services not completed by the end of the
month in which coverage terminates
- Orthodontic services.
This is not a complete listing of
exclusions. For a complete listing see the policy or certificate.
What is an Alternate Benefit?
An alternate benefit will apply: (1) If we determine that a less
expensive alternative procedure, service or Course of Treatment can be
performed in place of the proposed treatment to correct a dental
condition; and (2) the alternative treatment will produce a
professionally satisfactory result; then the maximum we will allow
will be the charge for the less expensive treatment.
This site provides a brief
description of the benefits, exclusions and other provisions of the
policy or certificate Form Master Policy #GH-1112-38090 issued to the
Voluntary Group Trust. For a complete listing, see the policy or
certificate. Benefits may vary in different states. This dental
insurance plan may not be available in all states. ©2005 HPA, Inc.
All rights reserved. S105121 (10/03)