Annual and Lifetime Maximums
Basic and Major Restorative Services: non
Orthodontic Services: Lifetime maximum of $750 per person under age 19

Deductible
Basic and Major Restorative Services and Orthodontic Services are subject to a $25 deductible per individual per calendar year. There is a combined family deductible of $50 per calendar year.

Limitations
In the event of a treatment by more than one provider, the Plan will not pay more than it would have if a single provider had performed the entire services.

Predetermination of Benefits
The Dental Plan recommends a Predetermination of Benefits for any extensive treatment such as periodontics, orthodontics, prosthetics, or fixed bridges. A description of planned treatment and expected charges should be sent to the Plan before treatment is started. If there is a major change in the treatment, a revised predetermination of benefits is required. When there has not been a predetermination of benefits, your Plan will determine the expenses that will be included as covered expenses at the time the claim is received. Predetermination of Benefits does not guarantee payment and expires one year from date of issue. The estimate of benefits payable may change based on the benefits, if any, for which a person qualifies at the time services are completed.

Alternate Benefits
All covered procedures are subject to an alternate benfit allowance. When there is more than on technique or material type for a dental procedure, your Plan will reimburse for the procedure that has a lesser allowance. When alternat benefit is enforced, your benefits are not intended to interfere with the treatment plan recommended by your dentist. You and your dentist should discuss which treatment is best suited for you/patient, and may proceed with the original treatment plan regardless of the benefit determination. If the more expensive treatment is chosen, you are liable for the balance of the dentist's billed amount.

Exclusions
The Smile Saver Dental Assistance Plan does not cover:

• Oral hygiene instructions, plaque/tobacco control programs or dietary instructions
• Temporary procedures
• Replacement of lost or stolen appliances
• Implants and/or related procedures
• Services of dentists if fees or charges are claimed by hospitals, clinics, laboratories, or other institutions

• Grafting and/or splinting procedures, including related services

• Dental services for which the member incurs no charge. Dental care or treatment when such services are rendered by/to an individual by/to an immemdiate family member such as spouse, child, brother, sister, or parent of such persons spouse

• Dental services for cosmetic or esthetic purposes

• Appliances, prosthetics, restorations, or procedures for the purpose of altering vertical dimension, restoring or maintaining occlusion, splinting, or replacing tooth structure lost as a result of abration, attrition, or wear

• Services or treatment of disturbances of the temporomandibular joint

• Services or supplies which do not meet the accepted standars of dental practice

• Charges for any dental treatment started prior to the effective date of coverage and/or charges for treatment after the cancellation date of coverage

• Services recoverable by automobile no-fault benefits, worker's compensation, or similar legislation