• General Limitations

Questions about which plan is right for you? Let us help.
801-442-6293
Our dental plans have exclusions, limitations, and requirements that reduce or limit some of the services that are covered and the level of coverage. A partial listing of benefit limitations is found below. For a complete list of exclusions, limitations, and requirements, please contact us.

Preventive and Diagnostic Limitations
  • Oral examinations – Two per year
  • Cleanings – Two per year 
  • X-rays – Panoramic or complete intraoral once every 36 months; Bitewings two times per year for individuals younger than age 18 and once per year for individuals ages 18 and older; Sealants  Covered for dependents younger than age 15; limited to permanent molars and bicuspids without decay or restorations. Sealant repair/replacement is not covered within 36 months of application
  • Space maintainers – Covered for dependents younger than age 15
  • Fluoride – Covered for dependents younger than age 18; two applications per year
Basic Limitations 
  • Fillings – Repair or replacement is not covered within 24 months of original filling
  • Endodontics – Repeat procedures are not covered within 12 months of the original procedure when performed by the same provider
  • Periodontal surgery – One per quadrant every 36 months
  • Periodontal debridement – One per 36 months
  • Periodontal scaling/root planting – One per quadrant every 24 months
  • Periodontal maintenance – Two times per year in lieu of cleaning
Major Limitations 
  • Replacement of bridges, dentures, implants, or other prosthodontic devices due to normal wear or use, loss of remaining teeth, or change in supporting tissue is covered only after five years from the date of placement. Repair and/or adjustment of bridges, dentures, implants, or other prosthodontic devices due to normal wear or use is covered only after six months from the date of placement. Replacement or repair due to abuse, misuse, neglect, loss, or theft is not covered
  • Dentures – Rebasing is covered once every 36 months. Relining is covered once every 18 months
Orthodontic Limitations
  • Orthodontic services – Covered  for dependents younger than age 20; replacement or repair due to abuse, misuse, neglect, loss, or theft is not covered (note: not covered on Individual Plans)