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:
- replacement of a lost or stolen prosthetic device
- services and supplies that are partially or wholly cosmetic in nature
- supplies or services which are not furnished by a legally qualified dentist or denturist acting within the scope of his license
- charges for completion of claim forms, broken appointments, counselling, travel, communication costs or for advice by telephone
- charges for protective athletic appliances
- 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
- expenses for treatment required as a result of war, (declared or not) or participation in a riot, insurrection or civil commotion
- 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
- services or supplies for implantology, including tooth implantation, transplantation and surgical insertion of fabricated implants
- services or supplies in connection with any procedures excluded as an eligible expense
- any hospital charges for board and room and related services and supplies
- any dental examinations required by a third party
- services or supplies which are not medically necessary to the care and treatment of any existing or suspected injury or disease
- 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
- any charge which was considered an insured service of any provincial government plan at the time this plan/benefit was issued and subsequently was modified, suspended or discontinued
- dental treatment which is primarily experimental or for dietary planning, congenital or developmental malformation
- 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.
- any services which are covered by any government plan or program; or for which no charge is made; or which the Insurer is not permitted by law to cover.