Exclusions for AmFirst Dental Plans

These Exclusions Are For The Following AmFirst Dental Plans

(This Includes Indemnity and PPO's)

AmFirst DPO - PPO

AmFirst Indemnity - Dental Indemnity Insurance

Comments that are highlighted in Blue are observations by Savon

LIMITATIONS - The following Limitations apply only to the insured portion of the dental plan.

Optional Services - Services that are more expensive than the form of treatment customarily provided under accepted dental practice standards are called "Optional Services." Optional Services also include the use of specialized techniques instead of standard procedures. For example:

(a) A crown where a filling would restore the Tooth
(b) A precision denture/partial where a standard denture/partial could be used;
(c) An inlay/onlay instead of an amalgam restoration;
(d) A composite/resin restoration instead of an amalgam restoration on posterior teeth.

If you receive Optional Services, your Benefits will be based on the lower cost of the customary service or standard practice instead of the higher cost of the Optional Service. You will be responsible for the difference between the higher cost of the Optional Service and the lower cost of the customary service or standard practice.

EXCLUSIONS - The following Exclusions apply only to the insured portion of the dental plan.

a) Treatment of injuries or illness covered by workers’ compensation or employers’ liability laws; services received without cost from any federal, state or local agency, unless this exclusion is prohibited by law.
Since Savon is not Insurance, if you have workers' compensation or are self-employed, you are still entitled to your Savon benefits.

b) Cosmetic surgery or procedures for purely cosmetic reasons, or services for congenital (hereditary) or developmental malformations. Such malformations include, but are not limited to cleft palate, upper and lower jaw malformations, enamel hypoplasia (lack of development), fluorosis (a type of discoloration of the teeth) and anodontia (congenitally missing teeth)
c) Treatment to restore tooth structure lost from wear, erosion, or abrasion; treatment to rebuild or maintain chewing surfaces due to teeth out of alignment or occlusion; or treatment to stabilize teeth. For example; equilibration, periodontal splinting, occlusal adjustment.
d) Any Single Procedure started before the patient is covered under this program.
e) Prescribed drugs, medication or painkillers.
f) Experimental procedures.
g) Charges by any hospital or surgical or treatment facility and any additional fees charged by the Dentist for treatment in any such facility.
h) Charges for anesthesia, other than by a licensed Dentist for administering general anesthesia in connection with covered oral surgery services.
i) Extra oral grafts (grafting of tissues from outside the mouth to oral tissues).
j) Services for any disturbance of the temporomandibular joints (jaw joints).
k) Treatment by someone other than a Dentist or a person who by law may work under a Dentist’s direct supervision.
l) For services provided outside the United States, its territories, or possessions, other than emergency dental treatment, unless the Primary Enrollee resides outside the United States, its territories, or possessions.
m) The initial installation of a fixed bridge or partial denture is not a benefit unless the bridge or denture is made necessary by natural teeth extraction occurring during a time the patient was eligible under this dental plan.
Unless you have a tooth extracted while insured by this company, there is no benefit for any prosthetic appliance (dentures or partials) or fixed partial denture (bridges).

Updated 09/21/2016