AFLAC DENTAL – A81000 SERIES

In Arkansas, Policies A81100AR–A81300AR. In Delaware, Policies A81100–A81300. In Idaho, Policies A81100ID–A81300ID. In New York, Policies NY81100–NY81300. In Oklahoma, Policies A81100OK–A81300OK. In Oregon, Policies A81100OR–A81300OR. In Pennsylvania, Policies A81100PA–A81300PA. In Texas, Policies A81100TX–A81300TX. In Virginia, Policies A81100VA–A81200VA.

Limitations and Exclusions for residents of Arizona:

1. This policy does not cover losses caused by or resulting from:
   1. Any procedure not shown on the Schedule of Dental Procedures.
   2. Services that are not recommended by a Dentist or that are not required for the preservation or restoration of oral health.
   3. Repairs to dental work within six months of the initial work.
   4. Replacement prosthetics within five years of last placement.
   5. Treatment involving crowns for a given tooth within five years of last placement, regardless of the type of crown.
   6. Replacement for inlays or onlays for a given tooth within five years of last placement.
   7. Treatment received while outside the territorial limits of the United States or, if outside the United States, the territorial limits of the place where your policy was issued.
2. Benefits for sealants are limited to secondary molars for dependent children under age 16 and will not be payable more often than every five years.
3. No benefits will be paid for replacement of teeth missing before the effective date of coverage.

Limitations and Exclusions for residents of Idaho:

1. This policy does not cover losses caused by or resulting from:
   1. Any procedure not shown on the Schedule of Dental Procedures.
   2. Services that are not recommended by a Dentist or that are not required for the preservation or restoration of oral health.
   3. Repairs to dental work within six months of the initial work.
   4. Replacement prosthetics within five years of last placement.
   5. Treatment involving crowns for a given tooth within five years of last placement, regardless of the type of crown.
   6. Replacement for inlays or onlays for a given tooth within five years of last placement.
   7. Treatment received while outside the territorial limits of the United States or, if outside the United States, the territorial limits of the place where your policy was issued.
2. Benefits for sealants are limited to secondary molars for dependent children under age 16 and will not be payable more often than every five years.
3. No benefits will be paid for replacement of teeth missing before the effective date of coverage.

Limitations and Exclusions for residents of New Jersey:

1. This policy does not cover losses caused by or resulting from:
   1. Any procedure not shown on the Schedule of Dental Procedures.
   2. Services that are not recommended by a Dentist or that are not required for the preservation or restoration of oral health.
   3. Treatment received while outside the territorial limits of the United States or, if outside the United States, the territorial limits of the place where your policy was issued.
2. No benefits will be paid for replacement of teeth missing before the effective date of coverage.

Limitations and Exclusions for residents of Virginia:

1. This policy does not cover losses caused by or resulting from:
   1. Any procedure not shown on the Schedule of Dental Procedures.
   2. Services that are not recommended by a Dentist or that are not required for the preservation or restoration of oral health.
   3. Repairs to dental work within six months of the initial work.
   4. Replacement prosthetics within five years of last placement.
   5. Treatment involving crowns for a given tooth within five years of last placement, regardless of the type of crown.
   6. Replacement for inlays or onlays for a given tooth within five years of last placement.
   7. Treatment received while outside the territorial limits of the United States or, if outside the United States, the territorial limits of the place where your policy was issued.
2. Benefits for sealants are limited to secondary molars for dependent children under age 16 and will not be payable more often than every five years.
3. No benefits will be paid for replacement of teeth missing before the effective date of coverage.

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