Missing tooth clause

A missing tooth clause is a plan rule about teeth that were missing or removed before your coverage took effect. The ADA explains that some plans restrict coverage for dental conditions present before enrollment, such as missing teeth. These are called pre-existing condition exclusions.

NADP notes that the only pre-existing condition that is common in dental plans is a missing tooth. In practice, the plan may not pay to replace that tooth with a bridge, implant, or denture. Some plans reduce this exclusion by the amount of prior creditable coverage.

Read the exclusions section of your plan. If you plan to replace a tooth, ask whether the clause applies. A pre-determination may confirm it. See also waiting period. The insurance and financing page has this office's information.