Exclusions Snapshot
The Insured Member cannot join and receive cover for a previously extracted tooth. (The Administrator must have the extraction on record as paid for cover to be granted for an implant)
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Full exclusions are described in the Policy Document and is available for viewing and download. For easy of use to assist you with making your decision on joining Dental Risk Insurance, please take note of the following important points:
Back Claiming
Implants
General Exclusions
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Changing existing fillings / crowns / caps for reasons including headaches, fatigue or other conditions not directly related to the tooth structure and for cosmetic reasons is excluded
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Once DRUM has received the panoramic scan, DRUM will identify all:
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missing teeth,
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existing crowns,
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existing implants and
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existing temporary crowns.
Existing crowns, existing implants and existing temporary crowns will be ruled as pre-existing conditions and will have an additional waiting period applied to them for a period of 5 (five) years. After the additional period of 5 years is completed, the policyholder may apply to have these procedures redone.
No dental claims for treatments received during the respective waiting periods will be paid once the waiting periods are over – all claims need to be dated for treatments received once the waiting periods are over.
Impacted Teeth
Cosmetic Procedures
Teeth that are in the process of eruption, but are not impacted are excluded.
No benefit will be paid unless the clinical functionality of the mouth / tooth is effected according to our protocols.