DENTAL INSURANCE POLICY EXCLUSIONS?

Dental insurance benefits will not be available for following conditions:

  1. services or supplies which are not described in Appendix A of the dental insurance policy or here;
  2. any treatment once the annual maximum number of treatments or maximum annual benefit limit has been reached;
  3. any treatment (other than for emergency and accident treatment or oral cancer) which is provided by any other clinic than the one submitted on the application form or is in the list of partner clinics.
  4. any dental treatment which took place on or prior to the insured person’s commencement date and treatment received after the policy period ceases;
  5. cosmetic treatments and treatments not clinically necessary;
  6. treatments designed to replace teeth which were already missing on or prior to your commencement date;
  7. any treatment resulting from self-inflicted injury;
  8. treatment involving the necessity of hospital in-patient, day-patient or out-patient care;
  9. services or supplies which are experimental in nature, or not normally supplied by a dental practice, or which are not clinically necessary;
  10. any treatment relating to damage or injury caused whilst participating in any physical contact sports when the appropriate tooth, mouth or head protection was not being worn;
  11. injuries sustained while engaged in illegal, unlawful or anti-social activities;
  12. reimbursement for travelling expenses or telephone calls in connection with any treatments or charges for completing the claim form;
  13. charges resulting from missed appointments;
  14. any claims for the replacement of dentures damaged whilst not being worn;
  15. any treatment charges which qualify for reimbursement under state dental provision or any other form of insurance, regardless of whether or not the insured person claims these benefits from the state or other insurance providers;
  16. charges resulting from missed appointments;
  17. oral cancer diagnosed, suspected, or for which tests were conducted or planned or for which a referral to a specialist had been made prior to the insured person joined the plan;
  18. oral cancer resulting from smoking or chewing tobacco products (including betel nut juice);
  19. for costs which are not reasonably and necessarily incurred. All benefits will be paid in accordance with customary and accepted levels of charges for the treatment received. The charges must be reasonable, necessary, incurred wholly and exclusively for the purposes of treatment and in line with our dental advisor’s opinion;
  20. Notwithstanding any provision to the contrary within this insurance or any endorsement thereto it is agreed that this insurance shall exclude war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, or military or usurped power or terrorism but only as the sole result of the utilisation of nuclear, chemical or biological weapons of mass destruction howsoever these may be distributed or combined. For the purpose of this clause:
  • Terrorism means an act, or acts, of any person, or group(s) of persons, committed for political, religious, ideological or similar purposes with the intention to influence any government and/or to put the public, or any section of the public, in fear. Terrorism can include, but not be limited to, the actual use of force or violence and/or the threat of such use. Furthermore, the perpetrators of terrorism can either be acting alone, or on behalf of, or in connection with any organisation(s) or governments(s).
  • The utilisation of nuclear weapons of mass destruction means the use of any explosive nuclear weapon or device or the emission, discharge, dispersal, release or escape of fissile material emitting a level of radioactivity capable of causing incapacitating disablement or death amongst people or animals.
  • The utilisation of chemical weapons of mass destruction means the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous chemical compound which, when suitably distributed, is capable of causing incapacitating disablement or death amongst people or animals
  • Utilisation of biological weapons of mass destruction means the emission, discharge, dispersal, release or escape of any pathogenic (disease producing) micro-organism(s) and/or biologically produced toxin(s) (including genetically modified organisms and chemically synthesised toxins) which are capable of causing incapacitating disablement or death amongst people or animals.

IMPORTANT TO KNOW: