IQVIA Benefits Handbook
BENEFITS NOT COVERED BY THE DENTAL PLAN
The following expenses are not covered under the Dental Plan:
- Bite registrations; precision or semi-precision attachments; splinting.
- Charges above the Program Allowance.
- Charges made by a hospital performing services for the U.S. Government for a condition connected to military service.
- Charges that would not have been made if you had no insurance.
- Charges you are not legally required to pay.
- Cosmetic dentistry.
- Dental services that do not meet common dental standards.
- Charges covered under an auto insurance policy in compliance with the "no-fault" or uninsured motorist law. Delta Dental will take into account any adjustment option you or any of your dependents choose.
- Charges that are paid or are eligible for payment through a public program, other than Medicaid.
- Charges that are unlawful where you reside when the expenses are incurred.
- Experimental or investigational procedures and treatments.
- Injury resulting from, or in the course of, any employment for wage or profit.
- Instruction for plaque control, oral hygiene and diet.
- Medical services.
- Prescription drugs.
- Procedures, appliances or restorations, other than full dentures, that:
- Change vertical dimension.
- Diagnose or treat conditions of TMJ.
- Stabilize periodontally involved teeth.
- Restore occlusion.
- Procedures performed by a dentist who is a member of the covered person's family (e.g., spouse, siblings, parents, children, grandparents and the spouse's siblings and parents).
- Replacement of a bridge or denture within five years of installation or if it still meets the dental standards of functional acceptability.
- Replacement of a lost or stolen appliance.
- Services and supplies received from a hospital.
- Sickness covered under any Workers' Compensation or similar law.
- Unnecessary care, treatment or surgery.
In addition, your benefits will be reduced so that the total payment will not be more than 100% of the charge made for a dental service, if benefits are provided for that service under this plan and the IQVIA Medical Plan.