Understanding the Limits of Dental Coverage
Q: What types of dental services are not covered?
A: The plan does not cover cosmetic treatments, dental services for congenital defects, and orthodontic treatments for children under the age of six.
Tom’s daughter Emily had been struggling with misaligned teeth for a while. When they visited the dentist, the doctor suggested a cosmetic procedure to improve the appearance of Emily’s smile, such as tooth reshaping or teeth whitening. Tom was hopeful that the plan would cover it, but he quickly learned that cosmetic dental procedures are excluded from the benefits. This meant Emily would not be able to use the plan to cover the cost of these elective services.
Additionally, Emily was born with a congenital dental defect that affected the shape of her teeth. Tom wondered if the plan might cover any treatments for this issue. Unfortunately, congenital dental defects are also excluded from coverage under the plan unless they involve medically necessary orthodontics. Tom was disappointed to realize that the plan would not cover the costs of treatment for Emily’s condition.
When Emily turned five, her dentist recommended braces to help realign her teeth. Tom knew the cost of orthodontics could be high, but he hoped the plan would assist. However, since Emily was still under the age of six when the suggestion was made, the plan did not provide coverage for orthodontic treatments. Once Emily was older and met the eligibility requirements, Tom would be able to receive up to $3,000 in orthodontic coverage for Emily’s treatment.