GENERAL LIMITATIONS
The Membership does not share in:
- cosmetic treatment
- replacement for accidental injured teeth
- treatment shared under any other membership
- treatment furnished in a US government hospital
- treatment performed before the employee or family member started on the membership
- services not performed by a dentist except for those services of a licensed dental hygienist which are supervised and billed by a dentist for scaling and polishing of teeth; or fluoride treatments
- treatment required because of teeth grinding (except for occlusal guards)
- replacement of a lost, missing, or stolen crown, bridge, or denture
- services or supplies which are covered by any workers’ compensation laws or occupational disease laws
- services or supplies, which are, covered by any employers’ liability laws
- services or supplies which any employer is required by law to furnish in whole or part
- services or supplies for which no charge would have been made in the absence of dental membership benefits
- services or supplies which are deemed experimental in terms of generally accepted dental standards
- use of materials or home health aides to prevent decay, such as toothpaste or fluoride gels, other than topical application of fluoride
- instruction for oral care such as hygiene or diet
- charges by the dentist for completing dental forms
- sterilization supplies
- charges for broken appointments
- treatment that would otherwise be free to you.
Diagnostic and Preventive Limitations
The Membership does not share in:
- education or training and supplies used for personal oral hygiene or plaque control and dietary or nutritional counseling
- treatment or appliances to increase vertical dimension (the length of the face determined by the distance of the separation of jaws)
Restorative Limitations
The Membership does not share in:
- reimbursement for a temporary and a permanent crown is limited to the permanent crown charge
- adjustments to dentures within six months of installation
- specialized techniques, precision attachments, personalization, or characterization of dentures
- reimbursement for a temporary and a permanent denture is limited to the permanent denture charge
- oral surgery postoperative
- oral surgery treatment of fracture and dislocation of a tooth
- orthognathic surgery
- replacement of wisdom teeth
- restorations to restore occlusion (chewing or grinding the surface of bicuspid and molar teeth), unless given in connection with orthodontic treatment
- surgery for Temporomandibular Joint Syndrome (TMJ/TMD)
STATE NOTICES AND DISCLOSURES
TEXAS Code Title 8, K, 1681.001
NOTICE: This health care sharing ministry facilitates the sharing of medical expenses and is not an insurance company, and neither its guidelines nor its plan of operation is an insurance policy. Whether anyone chooses to assist you with your medical bills will be totally voluntary because no other participant will be compelled by law to contribute toward your medical bills. As such, participation in the ministry or a subscription to any of its documents should never be considered to be insurance. Regardless of whether you receive any payment for medical expenses or whether this ministry continues to operate, you are always personally responsible for the payment of your own medical bills. Complaints concerning this health care sharing ministry may be reported to the office of the Texas attorney general.
Void where prohibited: Although American Dental Share offers memberships nationwide, some of the sharing options contained in the Membership Guidelines may NOT be available to Members in all geographic locations or jurisdictions.