HR and Benefits: Active Employee Handbook

Dental - What's Not Covered

Delta Dental does not cover the following services, treatment and/or fees:

  • cosmetic surgery or procedures for purely cosmetic reasons
  • services for congenital or developmental malformations
  • treatment to restore tooth structure lost from wear
  • treatment to rebuild or maintain chewing surfaces due to teeth out of alignment or occlusion
  • treatment to stabilize teeth (equilibration, periodontal splitting)
  • services for any disturbance of the temporomandibular joints (jaw joints) or myofacial pain dysfunction
  • services rendered by a dentist beyond the scope of his license
  • services performed by any person other than a dentist or auxiliary personnel legally authorized to perform services under the supervision of a dentist
  • charges by any hospital or other surgical or treatment facility and any additional fees charged by the dentist for treatment in any such facility
  • oral hygiene instruction or dietary instructions
  • prescribed drugs or other medication
  • experimental procedures
  • oral graft or conscious sedation
  • gold foil restorations (treated as an optional service)
  • implants or surgical removal of implants
  • charges for general anesthesia, other than by a dentist properly licensed to administer general anesthesia in connection with covered oral surgery services
  • dental services for which the eligible person incurs no charge
  • dental services with charges that exceed what would have been made and actually collected if no coverage existed hereunder
  • a posterior bridge where a partial denture in the same arch is not a covered benefit
  • temporary partial dentures are a benefit only when anterior teeth are missing
  • porcelain, gold or veneer crowns for children under 12
  • fixed bridges or cast partials for children under 16
  • services for injuries or conditions that are covered under Worker’s Compensation or Employer’s Liability Laws
  • services provided by any federal, state or local agency, unless this exclusion is prohibited by law