1. Charges for services or materials for which you are not, in the absence of this coverage, legally required to pay.

2. Charges for services or materials received from a dental or medical department maintained by an employer, a mutual benefit association, a labor union, or a health benefit plan, or for services or materials furnished by or at the direction of the United States Government or any state, province, or other political subdivision, unless you would be required to pay such charges in the absence of this Plan.

3. Charges for dental procedures you have incurred for the repair of sound natural teeth (including their replacement) required as a result of, and within 24 months, of an accidental bodily injury can be considered for benefit payment under medical expense benefits.

4. Charges for services or materials for cosmetic purposes, except for cosmetic dental procedures, incurred within 24 months of an accident.

5. Charges for facings on crowns, or pontics, posterior to the second bicuspid and/or bonding.

6. Charges due to war or any act of war, whether declared or undeclared.

7. Charges for any portion of a dental procedure performed before the effective date of or after the termination of your coverage for dental expense benefits, except eligible dental charges incurred for dental care furnished within 30 days after termination of coverage for dental expense benefits will be considered eligible for payment if:

a. The service involves an appliance, or modification of an appliance, for which the impression was taken prior to the termination of your coverage;

b. The service involves a crown, bridge or gold restoration for which the tooth was prepared prior to the termination of your coverage.

c. The service involved root canal therapy for which the pulp chamber was opened prior to the termination of your coverage; or

d. The procedure is completed within 30 days after termination of your coverage and you are not otherwise entitled to payment under any other like dental coverage of any type or source.

8. Charges for periodic oral examination and/or prophylaxis performed in excess of two procedures in any calendar year.

9. Charges for replacement of lost or stolen appliances, dentures, or bridgework.

10. Charges for dental appointments that are not kept.

11. Charges for any service or material not furnished by a dentist or denturist, except a service performed by a licensed dental hygienist or legally licensed professional authorized to perform dental services under the supervision of a dentist, or an x-ray ordered by a dentist.

12. Charges for the replacement of a prosthesis within five years after it was first placed, except for:

a. A crown which is needed for restoration only;

b. Replacement which is needed because of the first time replacement of an opposing full denture or the extraction of natural teeth;

c. A permanent prosthesis which replaces a stayplate or another temporary prosthesis;

d. Replacement of a prosthesis which, while in the mouth, has been damaged beyond repair as a result of an accident which occurs while covered by the Plan, Charges for prosthesis reline no more often than every 36 months.

TMJ -- Temporomandibular Joint Syndrome. Charges for necessary care and treatment of temporomandibular joint syndrome and associated myofacial pain are covered under the Active Employee Plan but are limited. See Exclusions, Limitations and Non-covered Charges under the Trust Medical Plan.