Exclusions & Limitations
You'll find general exclusions and limitations for Individual plan coverage here.
Delta Dental of Illinois individual plans do not provide coverage
for the following (see policy for definitions of terms used in this section):
- Dental procedures to treat injuries or conditions compensable
under worker's compensation or employer's liability laws.
- Dental procedures, including seating of appliances
and prosthetics (crowns, bridges and dentures), that were
provided or commenced prior to your, or a covered dependent's,
effective date of coverage under this policy.
- Prescription drugs, premedications or relative analgesia.
- Charges for anesthesia.
- Preventive control programs.
- Charges for completion of forms.
- Charges for consultations.
- Charges by any hospital or other surgical or treatment
facility, or any additional fees charged by a dentist for
treatment in any such facility.
- Charges for treatment of, or services related to,
temporomandibular joint dysfunction (TMJ).
- Services that are determined to be partially or wholly cosmetic in nature.
- Cast restorations placed on covered dependents under age 12.
- Prosthetics placed on covered dependents under age 16.
- Oral surgical procedures except as noted.
- Appliances, restorations, or procedures for: (a) increasing
vertical dimension; (b) restoring occlusion; (c) correcting
harmful habits; (d) replacing tooth structure lost by attrition;
(e) correcting congenital or developmental malformations,
unless restoration is needed to restore normal bodily function,
except in newly born children; (f) temporary dental procedures;
(g) implantology techniques; (h) splints, unless necessary as
a result of accidental injury.
- Dental procedures provided by someone other than a dentist
or licensed hygienist employed by a dentist.
- Dental procedures to treat injuries or diseases caused by
riots or any form of civil disobedience.
- Dental procedures to treat injuries sustained while
committing a criminal act.
- Dental procedures to treat injuries intentionally inflicted.
- Replacement of lost or stolen dentures or charges for duplicate dentures.
- Dental procedures in cases for which, in the professional
judgment of the attending dentist, a satisfactory result cannot be obtained.
- Local anesthetic is covered as a part of a dental procedure.
- Procedures or benefits not specifically covered under
this policy or excluded by Delta Dental rules and regulations,
including Delta Dental processing policies, which may change
periodically, and are printed on the Explanation of Benefits
and Explanation of Payment forms.
Coverage for some services under Delta Dental of Illinois
individual plans is subject to frequency and age limitations.
These limitations and restrictions are described in the policy.
A copy of the policy is available by calling Delta Dental of Illinois at 800-3231743.
Need additional guidance?
For customer service or claims questions, please contact Delta
Dental of Illinois Customer Service at 800-323-1743, 7 am – 7 pm
Monday – Thursday, 7 am – 6 pm Friday Central Time , or email
You can check claim
status through the Subscriber Connection 24/7.