pdent blue cross coverage

For all of your dental questions and/or claim forms, please contact your local Blue Cross Blue Shield company. As a member of Blue Cross Blue Shield FEP Dental, we aim to provide the highest level of service available. Blue Cross Blue Shield of Minnesota 0000004371 00000 n Limitations and Exclusions Exclusions startxref Periodontal maintenance Bitewing X-rays If you're not familiar with the health insurance terms used on a summary of benefits and coverage, here's a Glossary of Health Coverage and Medical Terms. 1996-document.write(new Date().getFullYear()); Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. =%V|'55KkW|_N&W4to;6ydLHO9;, mZ7mqDe"^=M'K#qFNHMDVx,>:'e ;>7o)rl-aX9]*E@l;Pz{XnGAc[=l V p\Z#'3WIHm"qq&.Sw76c\}oSm+qrA[Eg>95?Zqe"2//bZ^2OT FI"bT$.q+ Rz?>tFZm^-S~t;.3&lL5fFf$=u|A8P3*XK2Ex`Kd5.-Wy?N/e>622H#/r=$Ct^;lcEK v-wsmRT3X"/\{ D Most PDF readers are a free download. 4 Covered once per arch every 84 months. We will cover all overseas services at the in-network level for all members. Temporomandibular Joint Disorder (also known as TMJ, TMD, or TMJD) is also a disease that medical insurance carriers still question. Fillings and sealants. The Patient Protection and Affordable Care Act was signed into law on March 23, 2010, and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. 0000047131 00000 n Visits are covered twice a year. H\n0E The Medicare+Choice delivery option that includes health maintenance organizations, or HMOs (with or without a point-of-service component), preferred provider organizations (PPOs) and provider-sponsored organizations (PSOs). 0000007922 00000 n Fluoride treatments This new site may be offered by a vendor or an independent third party. Register Now, Not registered? The designation is based on evidence-based, objective selection criteria established with input from expert physicians and recommendations from medical organizations . The BlueCare Dental HMO network includes specialists such as oral surgeons, orthodontists, pediatric dentists, endodontists (specialists in diseases of the nerve within the tooth) and periodontists (specialists in diseases of the gums and tissues). You can watchthis videoto meet your health plan advisors. We will work with and follow all COVID-19 guidance and protocols provided by the Centers for Disease Control BlueCare Dental ConnectionSM is a program benefit that provides members with education and intervention through support tools and educational mailings. Box 551, Minneapolis, MN 55440-0551. Enables members to receive healthcare services wherever they live or travel, nationally or internationally. 2020-09-09T21:17:19-07:00 An extension of the Blue Cross Blue Shield WalkingWorks program, this event helps people incorporate physical activity into their workday and encourages them to increase their daily physical activity by walking at lunch. We have several tools and resources available to help you make informed decisions about your plan and make the most of your BCBS FEP Dental coverage. PII, as used in these Inter-Plan Programs Policies and Provisions, may have other meanings as assigned by various state laws related to data security breach notification. Preventive care like exams and cleanings. BlueCare Dental HMOSM is a Chicago metropolitan based program that emphasizes preventive and diagnostic care. It is only available under an insured funding arrangement for groups sized 51 or more lives. This includes services the doctor provides and other services your child might need like anesthesia. (Coverage is not available for non-network dentists in Massachusetts except for covered emergency services.) Get access to your agent portal. If you have further questions, call Customer Service at 1-855-504-2583 in the U.S. or 1-651-994-2583 See also precertification. Preventive care programs designed to determine if a health condition is present even if a member has not experienced symptoms of the problem. Complete your health care coverage with a dental plan from Blue Cross and Blue Shield of . A group of healthcare providers that agrees to deliver coordinated care, meeting performance benchmarks for quality and affordability in order to manage the total cost of care for their member populations. An information system that incorporates membership data and provider reimbursement arrangements and analyzes transactions according to contract rules. Alberta. This includes services the doctor provides and other services your child might need like anesthesia. 2023 Blue Cross Blue Shield Association. Any dental plan offered by an organization that provides a benefit plan that differs from a traditional fee-for-service plan. Limited to once every 24 months for primary teeth, and once every 48 months for permanent teeth. Your employer should be able to provide a benefit booklet for you which will provide some details of your coverage. Sending a letter to Blue Cross Blue Shield FEP Dental, P.O. Fillings BlueCare Dental Choice PPO - This is known as an active plan design. 0000015769 00000 n The BlueCare Dental PPO product is a product available for purchase on a self-funded basis only. BlueCard links participating healthcare providers and the independent Blue Cross Blue Shield companies across the country through a single electronic network for claims processing and reimbursement . Patients and members can also call Yavapai Regional Medical Center at 702-616-5789 for assistance or questions. HUKo@WoR",8iiz5f. Also known as a computer-based patient record. In Texas, Medicaid is the program that will offer the most comprehensive dental coverage, especially for children (anyone under 21). trailer Once youve reached this out-of-pocket maximum, your plan pays 100 percent of the allowed amount. Information that relates to an individual's past, present, or future physical or mental health or condition, or the past, present, or future payment for the provision of health care to an individual, including demographic information, received from or on behalf of a health care provider, health plan, clearinghouse, or employer, which either identifies the individual or could be reasonably used to identify the individual. Basic services like fillings and root canals. premium table below. See the chart on the back for more plan details. PBC pays the pharmacy 80% of your prescription cost, and you pay the pharmacist the remaining 20%. 0000015127 00000 n takes the health and well-being of our members, providers, our associates and our business partners seriously. 0000022849 00000 n 0000001675 00000 n WalkingWorks is a physical fitness and wellness program developed by Blue Cross Blue Shield, in cooperation with the Presidents Council of Physical Fitness and Sports, to help BCBS members reach fitness goals while improving your overall health. 0000002318 00000 n 0 If you continue to use this site we will assume that you are happy with it. 0000004814 00000 n Choose from a variety of affordable group health plans to fit the needs of your employees and your business. Use ourProvider Finderto search for doctors and pharmacies near you. If you have a significant life event, you may still be able to get 2023 coverage through special enrollment. BlueCare Dental HMOSM Voluntary Plan is a PPO that requires no employer contribution while still offering the employees the benefit of dental coverage in one of the largest dental PPO networks. Features: Review member coverage Submit claims View claims history View your membership card The content on the Dental Wellness Center website is provided by go2dental.com. PDENT is your dental plan. An evaluation of the medical necessity, appropriateness and cost-effectiveness of healthcare services and treatment plans for a given patient. Acrobat Distiller 11.0 (Windows) gYpV:+ Most PDF readers are a free download. 0000003587 00000 n The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. 0000014575 00000 n Find a planto get a quote. In addition, some sites may require you to agree to their terms of use and privacy policy. Free language assistance to people whose primary language is not English, such as: Calling Blue Cross Blue Shield FEP Dental at 1-855-504-BLUE (2583), dial 711 for TTY relay services. Blue Cross and Blue Shield of Texas, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). Blue Cross Blue Shield FEP Dental xref 0000139675 00000 n 0000041318 00000 n External link You are leaving this website/app (site). PII does not include publicly available information that is lawfully made available to the general public from federal, state or local government records or widely distributed media. Here's what's new for 2023: For High Option members, you will pay nothing for in-network Class B and C services for children 13 and under. 0000076479 00000 n 0000076637 00000 n With the Premium plan preventive care is free and after 6 months the co-payment for fillings and simple extractions is just 20%. The integration of financing and delivery of healthcare within a system that seeks to manage the accessibility, cost and quality of that care. A process through which an organization validates credentialing information from the organization that originally conferred or issued the credentialing element to the practitioner. BCBSIL assumes no liability or responsibility for damage or injury to persons or property arising from the use of any product, information, idea, or instruction contained on the Dental Wellness Center Web site; go2dental.com is solely responsible for the content and any advice given on its website. Access educational information on a wide range of dental topics including pediatric care, prevention and dental treatments. Refer to this list for drug coverage information for Blue Cross members whose plan uses the Custom Select Drug List. a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Call us at 800-531-4456 or contact an independent, authorized Blue Cross and Blue Shield of Texas agent. HUQs6~W:Yc%v9^n.R`s?x%X:i2A-}'o$n @(LkPW[BTn e"+POlkk-boX:\(%r)%|z>n!RL&i q9zy JRah#J~xB2Wz 1e9d`\d"I`:=&8',a4$ldXaC]Z-2mJutPtX1nVXc "h|e2e4"*D=I An itemized statement of healthcare services and their costs provided by a hospital, physician's office or other provider facility. Limited to once every 24 months for primary teeth, and once every 48 months for permanent teeth. Also known as a medical-necessity review. Auxiliary or supplemental services, such as diagnostic services, home health services, physical therapy and occupational therapy, used to support diagnosis and treatment of a patient's condition. A plan under which an employer's group health plan, disability plan and workers' compensation program are merged, integrated or coordinated (depending on state regulations) into a single health benefit plan that covers employees 24 hours a day. An application for payment of benefits under a health plan. Get access to your employer portal.Register Now, Not registered? Table of Contents. These services are covered 12 months after you first join a Blue Dental plan. A national program that offers members traveling or living outside of their Blue Cross Blue Shield Plan's area the PPO (preferred provider organization) level of benefits when they obtain services from a physician or hospital designated as a PPO provider. The name Affordable Care Act refers to the final, amended version of the law. PDENT is your dental plan. Although you can go to any dentist of your choice, your benefits under BlueCare Dental PPO Rider will be greater when you use the services of an in-network dentist. The review and possible authorization of proposed treatment plans for a patient before the treatment is implemented. 0000010126 00000 n There is no need to submit a paper claim. An organization that provides dental services through a network of providers to its members in exchange for some form of prepayment. 2900 Ames Crossing Road ; Eagan, MN 55121 1-800-693-6703 . For all of your dental questions and/or claim forms, please contact your local Blue Cross Blue Shield company. Up to $800 of the $1,200 in-network total can be used toward out-of-network care. BlueCare Dental HMO offers a dental network that is one of the largest in Illinois. Check out our Member Education Materials to get more information aboutBlue Cross The three dental plans for children on Medicaid are: Dentaquest, MCNA Dental and UnitedHealthcare Dental. To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. p ?P\H19y+_Q /iY.Q6?/??h= $Ng3,M;Tz\LJhzs"N@?XGGy*& b UYUy>vcUbR!|ilJg 0 endstream endobj 19 0 obj <> endobj 20 0 obj <> endobj 21 0 obj <> endobj 22 0 obj <> endobj 23 0 obj [/DeviceN[/Cyan/Magenta/Black]/DeviceCMYK 53 0 R 55 0 R] endobj 24 0 obj <> endobj 25 0 obj <> endobj 26 0 obj <>stream Blue Cross Blue Shield Global Current Members Space maintainers are covered once per quadrant every two years for members to the end of the month of their 15th birthday. 0000045351 00000 n 0000036033 00000 n Learn more about dental services for adult STAR members, 8 a.m. to 5 p.m. Central Time Monday through Friday. Coverage for treatments varies depending on the member's benefit plan. A voluntary health insurance program for federal employees, retirees and their dependents and survivors. H\n0. 'on[/b,k"=|g/my6Johp!?yuv9R`LZM8eW$@'I#Z%%@CX2`A6*a)TtAMb?|,*+9 ?B%UFV)l)ypvwIH rtB!gvdPW;R13LmVDwfeLki]CxEb5n>OT|~_Yz[pw\;Oh1O70A|S|S? 0000012877 00000 n 1. Blue Distinction Centers for Specialty Care, Need to Make a Payment? A federal government program established under Title XVIII of the Social Security Act of 1965 to provide hospital expense and medical expense insurance to elderly and disabled persons. pdent blue cross coverage. Matthew Vannatta, Arkansas Blue Cross and Blue Shield Vice President of Consumer and Retail Markets talks to Nichole about changes to health coverages post-pandemic and how BCBS might be able to help. Basic services like fillings and root canals. 2021 SUMMARY OF BENEFITS Plan Type: PDENT BlueCare Dental Connection Take Advantage of Dental and Discount Programs As a valued member, you have access to a variety of tools and resources to help you and your loved ones manage your oral health and save money through our discount programs. Periodontal maintenance collect outside the U.S. BCBS FEP Dental has a larger nationwide network with nearly half a million provider access points. Need help understanding and choosing a benefit plan? Children can get pediatric benefits until the end of the calendar year in which they turn 19. Covered once per tooth every 60 months. Search for Doctors, Hospitals and Dentists Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. Our health plan advisors can help you choose a plan, calculate your costs and tell you whether you're eligible for a subsidy. In group health insurance, generally a condition for which an individual received medical care during the three months immediately prior to the effective date of coverage. Limited to twice a year in combination with routine cleaning. Programs designed to educate and motivate members to prevent illness and injury and to promote good health through lifestyle choices, such as smoking cessation and dietary changes. 0000021620 00000 n Sealants are covered once per fully erupted first and second permanent molar every 36 months for members to the end of the month of their 16th birthday. 0000072686 00000 n Scroll. %PDF-1.6 % A health maintenance organization (HMO) that contracts with a group of physicians with multiple specialties who are employees of the group practice. Select "Log In To My Account" from the large center banner Box 986030, Boston, MA 02298. Covered once per tooth per lifetime. A Medicare supplement that uses a preferred provider organization (PPO) to supplement Medicare Part B coverage. 0000029289 00000 n An individual or organization that offers care directly to the member. The focus is simple: offer employers multiple dental plan designs that allow greater flexibility to choose a design that best suits their needs at a reasonable price. Preventive care programs designed to monitor and promote the administration of vaccines to guard against childhood illnesses, such as chicken pox, mumps and measles, as well as adult illnesses, such as pneumonia and influenza. 0000006747 00000 n Fluoride treatments are covered twice a year for members to the end of the month of their 19th birthday. Plans to Fit Every Small Business Budget. It also gives you the freedom to choose any dentist you want by helping to cover the cost of care when you see a dentist who isn't in our PPO network. endstream endobj 8 0 obj <> endobj 6129 0 obj <> endobj 6130 0 obj <> endobj 838 0 obj <> endobj 2595 0 obj <>/K 1115 0 R/ParentTree 2597 0 R/ParentTreeNextKey 138/RoleMap 2695 0 R/Type/StructTreeRoot>> endobj 2596 0 obj <>/A0+1<>/A0_1<>/A1<>/A1+1<>/A1+2<>/A10<>/A10+1<>/A10_1<>/A11<>/A11+1<>/A11_1<>/A12<>/A12+1<>/A12+2<>/A12_1<>/A13<>/A13+1<>/A14<>/A15<>/A17<>/A2<>/A2+1<>/A2+2<>/A20<>/A3<>/A3+1<>/A4<>/A4+1<>/A4_1<>/A5<>/A5+1<>/A5_1<>/A6<>/A6+1<>/A6_1<>/A7<>/A7_1<>/A8<>/A8+1<>/A9<>/CM1<>/CM1+1<>/CM1+2<>/CM1+3<>/CM10<>/CM10+1<>/CM10+2<>/CM10+3<>/CM11<>/CM11+1<>/CM11+2<>/CM11+3<>/CM12<>/CM12+1<>/CM12+2<>/CM12+3<>/CM13<>/CM13+1<>/CM13+2<>/CM14<>/CM14+1<>/CM14+2<>/CM15<>/CM15+1<>/CM16<>/CM16+1<>/CM17<>/CM18<>/CM2<>/CM2+1<>/CM2+2<>/CM2+3<>/CM3<>/CM3+1<>/CM3+2<>/CM3+3<>/CM4<>/CM4+1<>/CM4+2<>/CM4+3<>/CM5<>/CM5+1<>/CM5+2<>/CM5+3<>/CM6<>/CM6+1<>/CM6+2<>/CM6+3<>/CM7<>/CM7+1<>/CM7+2<>/CM7+3<>/CM8<>/CM8+1<>/CM8+2<>/CM8+3<>/CM9<>/CM9+1<>/CM9+2<>/CM9+3<>/Pa0<>/Pa0+1<>/Pa0_1<>/Pa1<>/Pa1+1<>/Pa10<>/Pa10+1<>/Pa10_1<>/Pa11<>/Pa11+1<>/Pa11+2<>/Pa11_1<>/Pa12<>/Pa12+1<>/Pa12_1<>/Pa13<>/Pa13_1<>/Pa14<>/Pa14_1<>/Pa15<>/Pa15+1<>/Pa16<>/Pa16+1<>/Pa16_1<>/Pa17<>/Pa17_1<>/Pa18<>/Pa18_1<>/Pa19<>/Pa19_1<>/Pa2<>/Pa2+1<>/Pa20<>/Pa21<>/Pa21_1<>/Pa24<>/Pa25<>/Pa26<>/Pa28<>/Pa3<>/Pa3+1<>/Pa30<>/Pa4<>/Pa4+1<>/Pa5<>/Pa5+1<>/Pa5+2<>/Pa6<>/Pa6+1<>/Pa6_1<>/Pa7<>/Pa7+1<>/Pa7+2<>/Pa7_1<>/Pa8<>/Pa8_1<>/Pa9<>/Pa9+1<>/Pa9_1<>>> endobj 1115 0 obj <> endobj 2597 0 obj <><>]>> endobj 2695 0 obj <> endobj 2132 0 obj <>1036]/P 2131 0 R/Pg 997 0 R/S/Link>> endobj 2077 0 obj <>991]/P 2076 0 R/Pg 987 0 R/S/Link>> endobj 2033 0 obj <>990]/P 2031 0 R/Pg 987 0 R/S/Link>> endobj 2061 0 obj <>988]/P 2060 0 R/Pg 987 0 R/S/Link>> endobj 2212 0 obj <><>]/P 2211 0 R/Pg 972 0 R/S/P>> endobj 2580 0 obj <>1240]/P 2579 0 R/Pg 1008 0 R/S/Link>> endobj 1244 0 obj <>280 281 282]/P 1243 0 R/Pg 927 0 R/S/Link>> endobj 1242 0 obj <>263 264]/P 1241 0 R/Pg 927 0 R/S/Link>> endobj 1223 0 obj <>255 256 257]/P 1222 0 R/Pg 927 0 R/S/Link>> endobj 1211 0 obj <>167 168 169]/P 1210 0 R/Pg 910 0 R/S/Link>> endobj 1160 0 obj <>73]/P 1159 0 R/Pg 849 0 R/S/Link>> endobj 1159 0 obj <> endobj 849 0 obj <. IV. 0000062841 00000 n Defining TMJ for insurance purposes TMJ has a broad definition. c< r9J2InHV`@Lb`\a%diF`3200h f`ig`` a However, the lower benefit plan level will apply and out-of-pocket expenses will be higher when receiving dental services from dentists not in the BlueCare DentalSM network. 0000011650 00000 n Our AskBlue SM BCBS FEP Dental Plan Finder tool can help you select the right plan for your needs. Additionally, members may have to submit claims for reimbursement. Teeth cleaning (prophylaxis) 0000041754 00000 n A specified dollar amount that a member must pay out-of-pocket for a specified service at the time the service is rendered. This new site may be offered by a vendor or an independent third party. Questions? Also known as disease state management. Stage 4: Catastrophic coverage Once you've spent $6,550 out-of-pocket on prescription drugs in a plan year, you will pay a small copay or coinsurance for the . Blue Cross and Blue Shield of Texas (BCBSTX) covers emergency dental services your child gets in a hospital or ambulatory surgical center. In the context of a pharmacy benefit management (PBM) plan, a program that requires physicians to obtain certification of medical necessity prior to drug dispensing. 0000004667 00000 n application/pdf BCBS FEP Dental is here to help you learn more about your oral health. 0000006097 00000 n Calling BlueCard Eligibility will facilitate efficient payment for the provider. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. A document that provides background information about various underwriting impairments and suggests the appropriate action to take if such impairments exist. During this unprecedented time, we're taking action to support our members. Calling BlueCard Eligibility will facilitate efficient payment for the provider. Get access to your employer portal. Please note, this is a summary of features of Blue Cross Blue Shield FEP . Bridges and dentures Please call 1-888-288-2738 and we'll help. Understanding your Blue Cross Blue Shield FEP Dental coverage is the key to making the most of your benefits, keeping your smile healthy and protecting your overall health. To access your member services, please visit your BCBS company. Blue Cross and Blue Shield of Texas (BCBSTX) is providing access to the Dental Wellness Center website as a courtesy, as part of its BlueCare Dental Connection program.

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