Summary of Limitations & Exclusions for the Club "A" Dental Plan Dental Benefit

1. Any dental services which were not rendered by a dentist participating in our PPO panel unless the service is performed by a licensed dental hygienist under the supervision of a participating dentist or for an x-ray ordered by a participating dentist.
2. Any claim filed more than one year from the date of service will not be paid.
3. Benefits only apply to treatment rendered while a person is covered under the plan. Services provided before (or after) a period of eligibility can not be covered.
4. Services not listed in the Schedule of Benefits are not covered.

Dentcare also reserves the right to adopt and to apply from time to time such administrative policies as it deems reasonable in approving the eligibility of subscribers and the appropriateness of treatment plans and related charges.