GENERAL LIMITATIONS
The Membership does not share in:
- Cosmetic treatment.
- Replacement for accidentally injured teeth.
- Treatment shared under any other membership.
- Treatment furnished in a U.S. government hospital.
- Treatment performed before the member or family member started on the membership.
- Services not performed by a dentist, except for those services of a licensed dental hygienist supervised and billed by a dentist for scaling, 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 covered by any workers’ compensation or occupational disease laws.
- Services or supplies covered by any employers’ liability laws.
- Services or supplies an employer is required by law to furnish in whole or in part.
- Services or supplies for which no charge would have been made in the absence of dental membership benefits.
- Services or supplies deemed experimental under 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, training, and supplies used for personal oral hygiene, 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 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 permanent denture is limited to the permanent denture charge.
- Oral surgery postoperative treatments.
- Oral surgery treatment for the fracture and dislocation of a tooth.
- Orthognathic surgery.
- Replacement of wisdom teeth.
- Restorations to restore occlusion (chewing or grinding surface of bicuspid and molar teeth), unless provided in connection with orthodontic treatment.
- Surgery for Temporomandibular Joint Syndrome (TMJ/TMD).
STATE NOTICES AND DISCLOSURES
TEXAS Code Title 8, K, 1681.001
Notice: American Dental Share operates as a dental membership plan that facilitates the sharing of dental expenses among members. It is not an insurance company, and neither its guidelines nor its operational structure constitutes an insurance policy. Participation in this membership plan is entirely voluntary, and no member is legally obligated to contribute to another member’s dental expenses.
Participation in the plan or reliance on its documents should never be considered a substitute for dental insurance. Members are always personally responsible for their own dental expenses, regardless of whether they receive contributions from others or if the membership plan continues to operate.
Complaints or concerns regarding this dental membership plan 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 outlined in the Membership Guidelines may not be available to members in all geographic locations or jurisdictions.