University of Texas System
Heritage Series Plus - Plan
Resources
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Ask a Dentist
For dental health questions answered by a certified dentist.
Find a Dentist
Find a Dentist
To locate a participating network dentist for the Heritage Series plan.
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Limitations, Exclusions & Termination
Pre-existing Conditions
Limitations and exclusions apply with respect to the Member’s oral conditions without regard to whether such conditions existed before the effective date of the Member’s enrollment.
Limitations and Exclusions
Plan Benefits are not available for:
- Any services not specifically described in the Copayment Schedule (including
but not limited to any hospital or outpatient care facility cost associated with any dental service). - Any part of a dental service for which a charge is incurred before the
effective date of the Member’s enrollment. - Any dental service initiated after the Member’s enrollment ends.
- Services provided by Non-Plan Providers unless (a) for services of Non-Plan
Specialty Dentists as specifically provided in the SPECIALTY DENTIST SERVICES section of the Copayment Schedule or (b) for Emergency Services as specifically provided in the EMERGENCY PROCEDURES Article of the Evidence of Coverage. - Replacement of bridgework, dentures or other fixed or removable appliances unless (a) at least five years have elapsed since such appliance was provided as a Plan Benefit, or (b) during that five-year period, appliance becomes unusable and cannot be made usable due to the Member’s illness or an accident involving damage to the appliance while it is in use.
- Replacement of dentures or other removable appliances due to (a) damage while not in use or (b) loss or theft.
- Oral reconstruction using fixed bridgework or other fixed appliances if the overall treatment plan to achieve complete oral reconstruction involves the replacement of six or more teeth (whether those teeth are missing before treatment begins or are extracted as part of the overall treatment plan).
- Implants or any related implant appliances, or surgery for the insertion of implants or any related implant appliances, whether fixed or removable.
- Surgical removal of implants or implant appliances, or any surgical or non-surgical services to adjust, repair, replace, or treat any problem related to an existing implant or implant appliance, whether fixed or removable.
- Restorations or splints used to increase vertical dimension, restore occlusion, or replace or stabilize tooth structure lost by attrition.
- Orthodontic treatment involving therapy for myofunctional problems, TMJ (temporomandibular joint) dysfunctions, micrognathia, macroglossia, cleft palate or other growth and developmental abnormalities.
- Orthodontic treatment associated with orthognathic surgery, whether the treatment precedes or follows the surgery.
- Extractions of third molars (wisdom teeth) that are not symptomatic, whether or not the extractions follow the completion of orthodontic treatment. Examples of symptomatic conditions include decay, odontogenic cysts, chronic pericoronitis and infection.
- Treatment of malignancies, neoplasms or cysts, including but not limited to biopsies.
Orthodontic Extractions
Extractions by a Plan Provider for solely orthodontic purposes are not subject to the fixed Copayments shown for extractions in the Copayment Schedule. Instead, such extractions are subject to charges reflecting a 25% reduction from that Plan Provider's normal retail charges for such extractions.
Termination
The Member’s enrollment may be terminated as stated in the TERMINATION article of the Evidence of Coverage.