A limitation common to most dental insurance plans is the Familial Relation clause. This family-related exclusion means that a doctor cannot treat his or her immediate family members and file a claim for services rendered. This applies to both in-network and out-of-network providers.
The MDS Dental Practice and Benefits Committee recommends that you review the contract language of your family member’s plan to determine if you can submit a claim. Language among payers varies and the limitation may be stated in a variety of ways. Some examples of this contract language include: “immediate family or immediate family of spouse,” or “enrollee’s spouse, child, brother, sister, or parent,” or “a person who lives in the covered person’s home or who is related to the covered person by blood or marriage.”