DENTAL

Expenses Not Covered

Listed below are some of the expenses that are not covered by the Dental Plans (for a complete list of expenses that are not covered, contact Cigna at 1-800-CIGNA24 (244-6224):

Covered expenses for the Buy-Up and Basic Dental Plans will not include:

• Services performed solely for cosmetic reasons;
• Replacement of a lost or stolen appliance;
• Replacement of a bridge, crown or denture within 8 years after the date it was originally installed unless: (a) the replacement is made necessary by the placement of an original opposing full denture or the necessary extraction of natural teeth; or (b) the bridge, crown or denture while in the mouth, has been damaged beyond repair as a result of an injury received while a person is insured for these benefits;
• Any replacement of a bridge, crown or denture which is or can be made useable according to common dental standards;
• Procedures, appliances or restorations (except full dentures) whose main purpose is to: (a) change vertical dimension; (b) diagnose or treat conditions or dysfunction of the temporomandibular joint (other than TMJ/Occlusal guard and palliative treatment); (c) stabilize periodontally involved teeth; or (d) restore occlusion;
• Porcelain or acrylic veneers of crowns or pontics on, or replacing the upper and lower first, second and third molars;
• Bite registrations; precision or semiprecision attachments; or splinting;
• Instructions for plaque control, oral hygiene and diet;
• Dental services that do not meet common dental standards;
• Services that are deemed to be medical services;
• Services and supplies received from a Hospital;
• Services for which benefits are not payable according to the "General Limitations" section. No payment will be made for expenses incurred for you or any one of your Dependents:
  • for or in connection with an Injury arising out of, or in the course of, any employment for wage or profit;
  • for or in connection with a Sickness which is covered under any workers' compensation or similar law;
  • for charges made by a Hospital owned or operated by or which provides care of performs services for, the United States Government, if such charges are directly related to a military-service-connected condition;
  • services or supplies received as a result of dental disease, defect or injury due to an act of war, declared or undeclared;
  • to the extent that payment is unlawful where the person resides when the expenses are incurred;
  • for charges which the person is not legally required to pay;
  • for charges which would not have been made if the person had no insurance;
  • to the extent that billed charges exceed the rate of reimbursement as described in the Schedule;
  • for charges for unnecessary care, treatment or surgery;
  • to the extent that you or any of your Dependents is in any way paid or entitled to payment for those expenses by or through a public program, other than Medicaid;
  • for or in connection with experimental procedures or treatment methods not approved by the American Dental Association or the appropriate dental specialty society.

Covered expenses for the DMO Dental Plan will not include:

• Services not listed on the Patient Charge Schedule;
• Services provided by a Non-Network Dentist without Cigna Dental's prior approval (except in some cases of emergencies)
• Services related to an injury or illness paid under workers' compensation, occupational disease or similar laws;
• Services provided or paid by or through a federal or state governmental agency or authority, political subdivision or a public program, other than Medicaid;
• Services required while serving in the armed forces of any country or international authority or relating to a declared or undeclared war or acts of war;
• Cosmetic dentistry or cosmetic dental surgery (dentistry or dental surgery performed solely to improve appearance) unless specifically listed on your Patient Charge Schedule;
• General anesthesia, sedation and nitrous oxide, unless specifically listed on your Patient Charge Schedule. When listed on your Patient Charge Schedule, general anesthesia and IV sedation are covered when medically necessary and provided in conjunction with Covered Services performed by an Oral Surgeon or Periodontist;
• prescription drugs;
• Procedures, appliances or restorations if the main purpose is to : (a) change vertical dimension (degree of separation of the jaw when teeth are in contact); (b) diagnose or treat abnormal conditions of the temporomandibular joint (TMJ), unless TMJ therapy is specifically listed on your Patient Charge Schedule; (c) restore teeth which have been damaged by attrition, abrasion, erosion, and/or abfraction;
• Replacement of fixed and/or removable appliances that have been lost, stolen, or damaged due to patient abuse, misuse or neglect;
• Services associated with the placement or prosthodontic restoration of a dental implant;
• Services considered to be unnecessary or experimental in nature;
• Procedures or appliances for minor tooth guidance or to control harmful habits;
• Hospitalization, including any associated incremental charges for dental services performed in a hospital. (Benefits are available for Network Dentist charges for Covered Services performed in a hospital. Other associated charges are not covered and should be submitted to the medical carrier for benefit determination.);
• Services to the extent you or your enrolled Dependent are compensated under any group medical plan, no-fault auto insurance policy, or uninsured motorist policy;
• The completion of crown and bridge, dentures or root canal treatment already in progress on the effective date of your Cigna dental coverage;
• Coverage for crowns and bridges used solely for splinting or resin bonded retainers and associated pontics.

Note: Any exclusion above will not apply to the extent that coverage of the charges is required under any law that applies to the coverage.

Coordination with the Health Care Flexible Spending Account
If you have elected to participate in a Health Care Flexible Spending Account (FSA), dental expenses not covered by your Dental Plan may be reimbursable through the FSA, which gives you a tax break on eligible dental expenses not covered by your plan.

	Highlights Eligibility, Enrollment & Cost Plan Options Choosing a Network Dentist Making Changes Covered Expenses & Services Expenses Not Covered Coverage Rules Predetermination of Benefits Filing a Claim Numbers, Addresses & Links

Summary Plan Description
The legal summary of this benefit will be included in the 2008 Benefits Handbook.