Specialist Services for oral surgery, endodontics, periodontics or pediatric dentistry must be referred by the assigned Contract Dentist. You will pay for all Specialist Services, which are Benefits provided by a Contract Specialist, directly to the Contract Specialist. (Refer to Schedule A.) If there is not an available Contract Specialist in the area, there are no Benefits for Specialist Services.
SPECIALIST SERVICES PERFORMED BY AN OUT-OF-NETWORK DENTIST ARE NOT COVERED.
If the services of a Contract Orthodontist are needed, please refer to Orthodontics in Schedule A, Description of Benefits and Copayments and Schedule B, Limitations and Exclusions to determine Benefits.
