• General Limitations

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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)

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame a SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.


Cerrar

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038. 。


退出

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.


Thoát

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038. 번으로 전화해 주십시오.


종료

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बाहिरनिस्कनुहोस्

FAKATOKANGA’I: Kapau ‘oku ke lea fakatonga, ko e kau fakatonu lea te nau tokoni atu ta’etotongi, pea te ke lava ‘o ma’u ia. Telefoni ki he SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.


Hū‘anga ki tu‘a

ОБАВЕШТЕЊЕ: Ако говорите српски језик, услуге језичке помоћи доступне су вам бесплатно. Позовите Select Health Advantage: 1-855-442-9900 (TTY- Телефон за особе са отежаним говором или оштећеним слухом: 711)/Select Health: 1-800-538-5038.


IZLAZ

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.


Isara

ملحوظة: إذا كنت تتحدث العربية، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل بشركة SelectHealth Advantage: 1-855-442-9900 (رقم هاتف الصم والبكم: 711) / SelectHealth: 1-800-538-5038.


خروج

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.


Beenden

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги переводчика. Позвоните SelectHealth Advantage: 1-855-442-9900 (телетайп: 711) / SelectHealth: 1-800-538-5038.


выйти

សម្គាល់៖ បើសិនជាអ្នកនិយាយ ភាសាខ្មែរ សេវាជំនួយផ្នែកភាសា ដោយមិនគិតថ្លៃ គឺអាចមានសំរាប់ អ្នក។ សូមទូរស័ព្ទមក SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038 ។


ចាកចេញ

注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038. まで、お電話にてご連絡ください。


終了

ATTENTION : si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Contactez SelectHealth Advantage au 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.


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