Program Overview
	Medical/Prescription Drugs
	Dental
	Vision Care
	State Group Life Insurance
	Life and AD&D Insurance
	Long-Term Disability Insurance
	Flexible Spending Plan
	Employee Assistance Program
	Wellness
	Disability Insurance
	Administrative Information
	What Happens When...?

What Is Not Covered

It is important to understand what your plan covers and how much of your benefits it will pay.

The following is a list of exclusions and limitations under your dental plan. Please refer to the actual plan documents or contact the Employee Benefits Office for more details on limitations and exclusions:

• Services that are not considered reasonable and customary
• Services for care, treatment or supplies that are not prescribed, recommended or approved by an attending physician or dentist
• Routine dental exams or other preventive services and supplies
• Services or supplies determined by Aetna to be experimental or investigational
• Services performed by or for the government unless payment of the charge is required by law
• Services that would have been covered by the government, except for Medicaid
• Services for plastic surgery, reconstructive surgery, cosmetic surgery or other services and supplies which improve, alter or enhance appearance; except to the extent needed to repair an injury suffered while you are covered
• Appliances, services, or supplies ordered while you were not covered
• Services for acupuncture therapy except when it is performed by a physician as a form of anesthesia in connection with covered surgery
• Injuries or diseases covered by workers' compensation or other occupational laws
• Charges for treatment that is deemed not medically necessary
• Any charge above the copayment percentage based on usual and customary charges. Where benefits are based on a schedule, the dental plans do not pay any amount that exceeds the scheduled benefits.
  

Copyright ©2021 Willis Towers Watson.