All claims must be filed within one year of the date of service.
The plan does not cover:
Services that do not qualify for payment according to our written guidelines. (These guidelines assist Altus Dental in making determinations as to whether services are covered and whether a particular service is the most cost-effective and commonly performed method of prevention, diagnosis or treatment. A service may not qualify for coverage under these guidelines even though it was furnished or recommended by a dentist.)
Any services that are not specifically covered in your group's Certificate of Coverage.
Services received from a dental or medical department maintained by or on behalf of an employer, mutual benefit association, labor union, trustee or similar person or group.
An illness or injury that Altus Dental determines is employment related.
Services you would not be required to pay for if you did not have this Altus Dental coverage.
Services provided by a dentist who is a member of your immediate family.
An illness, injury or dental condition for which benefits are, or would have been available, through a government program if you did not have this Altus Dental coverage.
Services rendered by someone other than a licensed dentist or a licensed hygienist if operating as authorized by applicable law.
Consultations, unless covered under your group's dental plan.
Disorders of the joints of the jaw (TMJ).
Services to increase the height of the teeth or restore occlusion.
Restorations required because of erosion, abrasion or attrition.
Services meant primarily to change or improve your appearance.
Occlusal guards and splints, unless covered under your group's dental plan.
Implants, bone grafts and transplants, unless covered under your group's dental plan.
Services to stabilize teeth, such as periodontal splinting, due to periodontal disease unless covered under your group's dental plan.
Prescription drugs, lab exams or reports.
Temporary bridges or crowns.
Services related to congenital anomalies.
General anesthesia/intravenous sedation for non-surgical extractions, diagnostic, preventive or minor restorative services.
General anesthesia/intravenous sedation administered by anyone other than a dentist.
Altus Dental also reserves the right to adopt and to apply from time to time such administrative policies as it deems reasonable in approving the eligibility of subscribers and the appropriateness of treatment plans and related charges.