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<br />LIMITATIONS AND EXCLUSIONS <br /> <br />'::overed Expenses will not include, and Dental Expense BenefIts will not be payable, for: <br /> <br />(1) any procedure begun: <br />(a) before the Covered Person was covered under this Policy, subject to the Prior Carrier Credit <br />Provision, if included in this Policy; or <br />(b) after termination of the Covered Person's coverage under this Policy, <br /> <br />(2) treatment or service which: <br />(a) is not recommended by a Dentist or is not provided by or under the direct supervision of a Dentist; <br />(b) is not a Necessary Dental Procedure, required for the care and treatment of a dental condition, as <br />determined by the Company; <br />(c) is not specifIcally listed as covered by this Policy; <br />(d) does not meet accepted standards of dental practice; <br />(e) is considered experimental or unproven in nature; or <br />(f) is provided by a physician or other health care provider, but is beyond the scope of his or her <br />license, <br /> <br />(3) charges which exceed Covered Expenses, as defmed in this Policy. BenefIts will not be payable when: <br />(a) total benefIt payments would exceed the annual maximum benefIts payable under this Policy; or <br />(b) services exceed the frequency limitations contained in this Policy. <br /> <br />(4) procedures which are subject to a BenefIt Waiting Period or a Late Entrant Limitation, until that BenefIt Waiting <br />Period or Late Entrant Limitation has been satisfIed. <br /> <br />(5) Orthodontic Procedures. <br /> <br />(6) any treatment or services which: <br />(a) are for mainly cosmetic purposes (facings or veneers on crowns or pontics distal to the second <br />bicuspid will be considered cosmetic); or <br />(b) are related to the repair or replacement of any prior cosmetic procedure, <br /> <br />(7) services related to the repair or replacement of third molars (wisdom teeth) with prostheses, <br /> <br />(8) bone grafts or any regenerative procedure in an extraction site. <br /> <br />(9) any procedure related to a dental disease or injury to natural teeth or bones of the jaw, which is considered a <br />covered service under any group medical plan, <br /> <br />(10) orthognathic recording, orthognathic surgery, osteoplasty, osteotomy, LeFort procedure, stomatoplasty or <br />magnetic resonance imaging (MRIs), <br /> <br />(11) initial placement of any prosthetic appliance or fIxed bridge; unless such placement is needed to replace one or <br />more functioning natural teeth extracted while the Covered Person is covered under this Policy, subject to the <br />Prior Carrier Credit Provision, if included in this Policy. Any such appliance or fIxed bridge must include the <br />replacement of the extracted tooth or teeth. <br /> <br />20 <br /> <br />Has TMJ, (I-ill) <br />09/01/01 <br /> <br />GL11-16B-EX FL <br />