35. Replacement of a lost or stolen appliance, Cast Restoration, or Denture. 36. Intra and extraoral photographic images.
37. Services or supplies furnished as a result of a referral prohibited by Section 1-302 of the Maryland Health Occupations Article. A prohibited referral is one in which a Health Care Practitioner refers You to a Health Care Entity in which the Health Care Practitioner or Health Care Practitioner’s immediate family or both own a Beneficial Interest or have a Compensation Agreement. For the purposes of this exclusion, the terms “Referral”, “Health Care Practitioner” , “Health Care Entity”, “Beneficial Interest” and Compensation Agreement have the same meaning as provided in Section 1-301 of the Maryland Health Occupations Article. This exclusion only applies for Maryland Sitused Groups
1 Some of these exclusions may not apply. Please see your Certificate of Insurance.
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DN-GCERT-GOLD Multioption Dental Benefit Summary
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