Dental Services Not Covered

The following expenses are not covered:

• Charges for missed appointments or completion of dental claim forms
• Prescription drugs
• Replacement of teeth, unless medically necessary
• Replacement of dentures, bridgework, crowns, or gold restorations less than five years old unless necessary because of disease or defect
• Lost, misplaced, or stolen dentures
• Replacement of an existing appliance unless:
  • Required because at least one additional tooth was necessarily extracted after the effective date of coverage
  • It replaces an existing appliance that is at least five years old and cannot be repaired, required as the result of accidental bodily injury
• Cast crowns for children under age 12
• Crowns for vertical dimension, to restore occlusion, bite registration, gnathology (jaw related), or periodontal (around the teeth) splinting
• General anesthesia
• Hospitalization expenses
• Cosmetic treatments can be covered under certain circumstances, but only at one of the Plan’s Dental Health Centers
• Occlusal adjustments, except for surgery or if included in orthodontic treatment unless necessary for periodontal purposes
• Experimental dental treatments
• Dietary planning services for oral hygiene/dental care
• Any injury covered under Workers’ Compensation or similar legislation
• Services payable under Medicare
• Services covered under the Boston University Health Plan
• Treatment furnished by a government or government agency, without charge, or by a member of your immediate family
• Expenses resulting from:
  • A sickness or injury from an illegal activity, self-inflicted injury
  • War, declared or undeclared
  • Engagement in a riot or insurrection
• Implantology
• Emergency treatment does not include any final restorations (ie., root canal, crowns, and dentures)