What Is Not Covered
While the JPMorgan Chase Dental Plan options cover a wide range of dental services, some expenses are not covered. These include but are not limited to those listed below.
For specific information on the PDP, DMO and DHMO's coverage exclusions and limits, please contact the appropriate claims administrator (MetLife, Aetna, or Cigna) directly (using the telephone numbers provided under "Where to Submit Claims"). The list of covered services and the list of excluded services may change at any time.
- Any of the following services:
- A gold restoration or crown, unless:
- It is treatment for decay or traumatic injury, and teeth can't be restored with a filling material; or
- The tooth is an abutment to a covered partial denture or fixed bridge.
- An appliance — or modification of one — if an impression for it was made before the person became covered.
- Any of the following services incurred more than 31 days after the date the person's coverage ends:
- A crown, bridge, or gold restoration for which the tooth was prepared while the person was covered;
- An appliance — or alteration of one — for which an impression was made while the person was covered; or
- Root canal therapy for which the pulp chamber was opened while the person was covered.
- Charges in connection with:
- A service to the extent that it is more than the usual charge made by the provider for the service when there is no insurance;
- Appliances or restorations needed to alter vertical dimensions or restore occlusion, or for the purposes of splinting or correcting attrition, abrasion, or erosion; or
- Replacement of lost, missing, or stolen appliances or appliances that have been damaged due to abuse, misuse, or neglect.
- Treatment for problems of the jaw joint, including:
- Craniomandibular disorder;
- Temporomandibular joint syndrome (TMJ), other than what is noted in "What Is Covered", or
- Other conditions of the joint linking the jaw bone and skull, and of the complex of muscles, nerves, and other tissues related to that joint.
- Expenses submitted later than December 31 of the year following the year in which services were provided.
- Installation of prosthetic devices (including bridges and crowns) while not covered or which were installed more than 31 days after coverage ends.
- Loss — or portion of a loss — for which mandatory automobile no-fault benefits are recovered or recoverable.
- Loss — or portion of a loss — resulting from war or act of war, declared or undeclared.
- Partial or full removable denture, removable bridge, or fixed bridgework if it includes replacement of one or more natural teeth (including congenitally missing teeth) missing before the person became covered under this Plan. The exclusion does not apply if the denture, bridge, or bridgework also includes replacement of a natural tooth that:
- Is removed while the person is covered; and
- Was not an abutment to a partial denture, removable bridge, or fixed bridge installed during the previous five years.
- Procedures related to occupational illness or injury.
- Replacement or modification of a partial or full removable denture, a removable bridge or fixed bridgework, or for a replacement or modification of a crown or gold restoration or inlay/onlay within five years after that denture, bridgework, crown, inlay/onlay, or gold restoration was installed.
- Expenses or charges with respect to services rendered by hospitals, clinics, laboratories (except dental X-rays are covered), or other institutions.
- Services and supplies included as covered medical expenses under:
- Any other employer-sponsored plan that covers you, including Medicare;
- Any other governmental health program, except Medicaid; or
- Your JPMorgan Chase Medical Plan option.
- Services and supplies rendered in a veteran's facility or government hospital, or services furnished in whole or in part under the laws of the United States or any of its state or political subdivisions.
- Services furnished for cosmetic purposes. Facings on crowns or pontics — which are behind the second bicuspid — will always be considered cosmetic. This limitation does not apply if the service is needed as a result of accidental injuries sustained while a person is covered.
- Services that are not necessary services as determined by the claims administrator.
- Services to the extent that a benefit for those services is provided under any other program paid in full or in part, directly or indirectly, by JPMorgan Chase. This includes insured and uninsured programs. If a program provides benefits in the form of services, the cash value of each service rendered is considered the benefit provided for that charge.
- Services to the extent that the charges are above the prevailing charge in the area for dental care of a comparable nature. A charge is above the prevailing charge to the extent that it's above the range of charges generally made in the same or similar geographic area for dental care of a comparable nature. The geographic area and that range are determined by the claims administrator.
- Treatment by a dental or medical department maintained by or on behalf of an employer, a mutual benefit association, a labor union, a trustee, or a similar person or group.
- Expenses in connection with services, procedures, drugs, or other supplies that are determined by the claims administrator to be experimental, or still under clinical investigation by health professionals.
- Charges for oral hygiene programs (in home care), completion of claim forms by the provider on your behalf, and broken appointments.
- Services provided by a relative or a domestic partner, or for which a charge would not normally be made.
- Treatment by anyone except a licensed dentist (except for cleaning or scaling of teeth and topical application of fluoride performed by a licensed dental hygienist, if rendered under the supervision and guidance of a licensed dentist).
- Mail order orthodontics.
In addition, the DMO Option does not cover services provided to a person age five or older if that person becomes covered other than:
- As described for any period of enrollment agreed to by JPMorgan Chase and Aetna, Inc. This limitation does not apply to charges incurred:
Replacements of — or additions to — existing dentures or bridgework will be covered under the JPMorgan Chase Dental Plan only if at least one of the following conditions exists:
- The present denture or bridgework cannot be made serviceable, and it is at least five years old;
- It's necessary to replace teeth extracted after the present denture or bridgework was installed; or
- Replacement by a permanent denture is needed because the present denture is temporary, and replacement occurs within 12 months after the date the temporary denture was installed.
The missing tooth exclusion means that a charge is an ineligible charge if it is for a partial or full removable denture, removable bridge, or fixed bridgework if it includes replacement of one or more natural teeth missing before the person became covered under the Dental Plan. This exclusion does not apply if the denture, bridge, or bridgework also includes replacement of a natural tooth that: