Dental Plan (PPO)
The Blue Cross Blue Shield plan is a preferred provider organization (PPO) plan. It lets you choose any licensed dentist — in or out of network. When you use a Blue Cross Blue Shield network dentist, you lower your out-of-pocket costs because the network dentists have agreed to charge lower fees while your plan’s in-network services cover a larger share of the charges.
If you choose to use a dentist who doesn’t participate in the network, your out-of-pocket costs may be higher, and you are subject to any charges beyond Reasonable and Customary (R&C).
* Patient may be responsible for paying amounts over Usual and Customary.
- Routine Exam
- Cleanings (2 in 12 months)
- X-Rays
- Sealants (under age 16)
• Fillings for Cavities
• Periodontics – deep cleanings (High Plan Only)
• Endodontics – root canals (High Plan Only)
- Crowns
- Prosthodontics
- Bridge
You don’t need to have a primary care dentist or get referrals. Just use the Blue Cross Blue Shield directory and use Dental Network: BCBS Dentist Search_BlueCare Network to find dentists or specialists.
| Plan Features | Low Dental Plan | High Dental Plan |
|---|---|---|
| Annual Maximum | $750 | $1,500 |
| Diagnostic & Preventive Services | 100% deductible does not apply | 100% deductible does not apply |
| Deductible | $25 per person $75 per family | $50 per person $150 per family |
| Basic Services | 80% | 80% |
| Major Services | Not Covered | 50% |
| Orthodontia Child Only | Not Covered | $1,000 lifetime max *Child only coverage under 19 years old |