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<br />SUNNYISLES <br />5395246 <br /> <br />City of Sunny Isles Beach <br />DENTAL LIMITATIONS & EXCLUSIONS <br /> <br />Covered Expenses will not include and Dental Expense Benefits will not be payable for: <br /> <br />1. any procedure begun: <br />a) before the covered person was covered under the policy, subject to the Prior Carrier Credit <br />provision, if included in the policy; or <br />b) after termination of the covered person's coverage under the policy. <br /> <br />2. treatment or service which: <br />a) is not recommended by a dentist or is not provided by or under the direct supervision of a dentist; <br />b) is not a necessary dental procedure, required for the care and treatment of a dental condition; <br />c) is not specifically listed as covered by the policy; <br />d) does not meet accepted standards of dental practice; or <br />e) is provided by a physician or other health care provider, but is beyond the scope of his or her <br />license. <br /> <br />3. charges which exceed covered expenses, as defined in the policy. Benefits will not be payable when: <br />a) total benefit payments would exceed the annual maximum or lifetime orthodontic maximum benefits <br />payable under the policy; or <br />b) services exceed the frequency limitations contained in the policy. <br /> <br />4. procedures which are subject to a benefit waiting period or a late entrant limitation, until that benefit <br />waiting period or late entrant limitation has been satisfied. <br /> <br />5. orthodontic (Type IV) procedures: <br />a) which begin before the dependent child becomes covered under the policy for orthodontic services, <br />subject to the Prior Carrier Credit provision, if included in the policy; <br />b) received after the dependent child's coverage ends, due to attainment of the maximum age, or for <br />any other reason; or <br />c) received after coverage for Type IV services is terminated under the policy. <br /> <br />6. any treatment or services which: <br />a) are for mainly cosmetic purposes (facings or veneers on crowns or pontics distal to the second <br />bicuspid will be considered cosmetic); or <br />b) are related to the repair or replacement of any prior cosmetic procedure. <br /> <br />7. services related to the repair or replacement of third molars (wisdom teeth) with prostheses. <br /> <br />8. bone grafts or any regenerative procedure in an extraction site. <br /> <br />9. orthognathic recording, orthognathic surgery, osteoplasty, osteotomy, LeFort procedure, stomatoplasty or <br />magnetic resonance imaging (MRls). <br /> <br />FL <br /> <br />The Lincoln National Life Insurance Company <br />10 <br /> <br />2/9/2009 <br />