Exclusions & Limitations

Exclusions & Limitations

You'll find general exclusions and limitations for Individual plan coverage here.

Exclusions

Delta Dental of Illinois individual plans do not provide coverage for the following (see policy for definitions of terms used in this section):

  1. Dental procedures to treat injuries or conditions compensable under worker's compensation or employer's liability laws.
  2. Dental procedures, including seating of appliances and prosthetics (crowns, bridges and dentures), that were provided or commenced prior to your, or a covered dependent's, effective date of coverage under this policy.
  3. Prescription drugs, premedications or relative analgesia.
  4. Charges for anesthesia.
  5. Preventive control programs.
  6. Charges for completion of forms.
  7. Charges for consultations.
  8. Charges by any hospital or other surgical or treatment facility, or any additional fees charged by a dentist for treatment in any such facility.
  9. Charges for treatment of, or services related to, temporomandibular joint dysfunction (TMJ).
  10. Services that are determined to be partially or wholly cosmetic in nature.
  11. Cast restorations placed on covered dependents under age 12.
  12. Prosthetics placed on covered dependents under age 16.
  13. Oral surgical procedures except as noted.
  14. Appliances, restorations, or procedures for: (a) increasing vertical dimension; (b) restoring occlusion; (c) correcting harmful habits; (d) replacing tooth structure lost by attrition; (e) correcting congenital or developmental malformations, unless restoration is needed to restore normal bodily function, except in newly born children; (f) temporary dental procedures; (g) implantology techniques; (h) splints, unless necessary as a result of accidental injury.
  15. Dental procedures provided by someone other than a dentist or licensed hygienist employed by a dentist.
  16. Dental procedures to treat injuries or diseases caused by riots or any form of civil disobedience.
  17. Dental procedures to treat injuries sustained while committing a criminal act.
  18. Dental procedures to treat injuries intentionally inflicted.
  19. Replacement of lost or stolen dentures or charges for duplicate dentures.
  20. Dental procedures in cases for which, in the professional judgment of the attending dentist, a satisfactory result cannot be obtained.
  21. Local anesthetic is covered as a part of a dental procedure.
  22. Procedures or benefits not specifically covered under this policy or excluded by Delta Dental rules and regulations, including Delta Dental processing policies, which may change periodically, and are printed on the Explanation of Benefits and Explanation of Payment forms.

Limitations

Coverage for some services under Delta Dental of Illinois individual plans is subject to frequency and age limitations. These limitations and restrictions are described in the policy. A copy of the policy is available by calling Delta Dental of Illinois at 877-8242776.

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Need additional guidance?

For enrollment help or questions, please contact us at 877-824-2776, 8:30 a.m. to 5:00 p.m. central time, Monday through Friday or by email at individual@deltadentalil.com. For customer service or claims questions, please contact Delta Dental of Illinois Customer Service at 855-327-8336, Monday - Thursday 7:00 AM - 7:00 PM CST and Friday, 7:00 AM - 6:00 PM CST, or email csi@deltadentalil.com.