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Exclusions and Limitations D. Interceptive or phase I orthodontics; E. Changes in treatment necessitated by an accident; F. Treatment Involving: 1) Maxillo-facial surgery, myofunctional therapy, cleft palate, micrognathia, macroglossia 2) Hormonal imbalances or other factors affecting growth or developmental abnormalities; 3) Treatment related to temporomandibularjoint disorders; 4) Lingually placed direct bonded appliances and arch wires Cinvisible braces"); and 5) Functional appliances that are used in conjunction with fixed appliances. G. Diagnostic records: 1) Cephalometric x-rays and other x-rays; 2) Diagnostic tracings of cephalometric x-rays; 3) Photographs; and 4) Study models. 4. The retention phase of treatment shall Include the construction, placement, and adjustment of retainers, 5. Should a member or client terminate from the Plan for any reason and at that time be receiving orthodontic treatment, the Member and not SafeGuard shall be responsible for payment of the balance due for any orthodontic treatment performed after termination. The member's payment shall be increased by an additional $2,050 above the membe's co -payment and excluding any charges for diagnostic records, shall be prorated over the number of months to completion of active treatment, and be payable on such terms and conditions as are arranged between the Member and the orthodontist. 6. The retention phase of treatment, if required, shall include the construction, placement and adjustment of retainers, the maximum cost of which shall not exceed $250.00. 7. If a member does not require treatment or chooses not to start treatment after the participating SafeGuard orthodontist has completed a diagnosis and consultation, the Member will be charged a consultation fee of $25.00 in addition to the fees for such diagnostic records. 0041 -0 -SOB 25C-50 EL's 2.79