Dental Plans for Individuals and Families

Dental Plans for Individuals and Families www.ibcbsal.com/dental Covering What Matters: Blue Cross and Blue Shield of Alabama offers quality and aff...
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Dental Plans for Individuals and Families www.ibcbsal.com/dental

Covering What Matters: Blue Cross and Blue Shield of Alabama offers quality and affordable individual and family dental plans. Are you looking for dental only coverage? Or, do you already have a health plan and would like to add dental coverage? Whatever your needs may be — we cover what matters. You can always count on Blue Cross to look for ways to expand your coverage choices.

Expertise For over 75 years, Blue Cross and Blue Shield of Alabama has been providing access to quality coverage and dependable, local service. Our commitment to providing you products of value extends to millions of Alabamians. In fact, over 90 cents of every premium dollar goes toward paying member benefits.

Access to care Blue Cross and Blue Shield of Alabama offers access to a comprehensive network of providers that consists of more than 1,600 Alabama dentists.

Service As a member of the Blue Cross family, you can count on us to be there when you need us. Our award-winning Customer Service Department has the technology and knowledge that enables us to consistently exceed our members’ expectations.

Peace of mind When you carry a Blue Cross and Blue Shield of Alabama card, you carry peace of mind in your pocket. It’s a card that is respected by providers in Alabama and throughout the nation.

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Something to Smile About! With low annual deductibles and affordable monthly premiums, you’ll find a reason to smile when you get a Blue Cross and Blue Shield of Alabama dental plan. Our statewide dental care network of more than 1,600 providers is designed to deliver dental care at an affordable price. With three dental plans to choose from, finding quality dental coverage is easier than ever.

Enrolling is easy Enrolling in the plan of your choice is easier than ever.

• You can enroll in one of our dental plans by going to www.ibcbsal.com/dental



• Call 1-855-890-7416 to talk with an Insurance Advisor or to meet with a sales



representative or, • Mail in your paper application

Who is eligible for coverage? To be eligible for Dental Blue® or Dental Blue® Select, the contract holder must be:

• A resident of Alabama



• At least 19 years of age or older

To be eligible for Dental Blue® Plus, the following must apply:

• A resident of Alabama



• No age restrictions

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Choose the dental plan that’s best for you Our standard dental plan covers basic benefits such as regular dental exams, x-rays and cleanings.

Did you know? More people use blue toothbrushes

Our premium dental plan includes all of the same benefits as Dental Blue® – plus coverage for orthodontic services, crowns and dentures.

than red ones.

Our newest dental plan, which features all the benefits of Dental Blue® and has more comprehensive benefits for dependent children up to age 19.

Compare coverage highlights* MONTHLY PREMIUMS



Dental Blue®

Dental Blue® Plus

Dental Blue® Select

Self

$21

$32

Self plus one

$42

$66

Family Calendar Year Deductible Annual Maximum Benefits Pediatric Out-of-Pocket Maximum



$75 $129 $50 per member

$50 per member

To determine your premium go to www.ibcbsal.com and choose Shop for Plans or call at 1-855-890-7416 us $40 per member

$1,000 per member (age 19 and over). No maximum $1,000 per member $1,500 per member for dependents up to age 19 $700 (one child up to age 19); Not applicable Not applicable $1,400 (two or more children up to age 19) (continued on next page)

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COVERED BENEFITS Diagnostic and Preventive Services (No waiting period) • Dental Exams & x-rays • Routine cleanings

Dental Blue®

Dental Blue® Select

Dental Blue® Plus

Covered at 100%; Covered at 100%; Covered at 100%; Subject to calendar year deductible Subject to calendar year deductible Subject to calendar year deductible

Basic Services† • Fillings Covered at 75%; • Simple tooth extractions Subject to calendar year deductible • Root Canal (non-surgical) • Emergency Treatment for pain •R  epairs to crowns and dentures (fixed partials and removable)

Covered at 80%; Covered at 80%; Subject to calendar year deductible Subject to calendar year deductible

Major Services†† • Oral surgery • General anesthesia • Periodontic exams •R  emoval of diseased tissues and bones Additional Major Services†† •C  rown, inlays, onlays and dentures Orthodontic Services†† •C  overage for dependent children up to age 19 • L imited to a lifetime maximum of $1,500

Covered at 50%; Subject to calendar year deductible

Covered at 50%; Covered at 50%; Subject to calendar year deductible Subject to calendar year deductible

Not covered Covered at 50%; Covered only for members up Subject to calendar year deductible to age 19 at 50%; Subject to calendar year deductible Not covered

Covered at 40%; Subject to $150 deductible

Covered only for members up to age 19 at 50%; subject to a $150 calendar year orthodontic deductible, only when determined to be dentally necessary

*Benefits listed apply to in-network services. +180-day waiting period applies (this waiting period does not apply to members up to age 19, enrolled in Dental Blue Plus). ++365-day waiting period applies (this waiting period does not apply to members up to age 19, enrolled in Dental Blue Plus. Dental Blue Plus members up to age 19 have a 24-month waiting period for dentally necessary orthodontic services).

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Commonly asked questions Who is eligible to enroll? To be eligible for Dental Blue® or Dental Blue® Select, you must be a resident of Alabama and at least 19 years of age or older. To be eligible for Dental Blue® Plus, you must be a resident of Alabama, however, no age restrictions apply.

Do I need to have a Blue Cross health plan to purchase a dental plan? No, our plans are dental only plans for individuals or families. No matter where you have your health coverage, you can enjoy Blue Cross dental coverage.

How do I pay? You may pay your monthly premium by bank draft, check, credit card (Discover®, MasterCard® or Visa®) or debit card (with a MasterCard® or Visa® insignia). You may also choose to receive your statements electronically or in paper form.

What are the waiting periods? Dental Blue® – 180-day waiting period for all Basic Services; 365-day waiting period for all Major Services. Dental Blue® Select – 180-day waiting period for all Basic Services; 365-day waiting period for all Major Services; 365-day waiting period for Orthodontic Services. Dental Blue® Plus – Adults (age 19 and older) 180-day waiting period for all Basic Services; 365-day waiting period for all Major Services; Children (up to age 19) 24-month waiting period for dentally necessary Orthodontic Services.

What are “dentally necessary Orthodontic Services”? Dentally necessary orthodontia is covered for the treatment of congenital or hereditary conditions which result in craniofacial abnormalities which would require medically necessary surgical correction (as determined by the plan) due to problems related to swallowing, chewing, speaking, breathing, or for acute injury to the teeth from an external force which cannot be stabilized by any other method.

Is there an annual open enrollment? Dental Blue® and Dental Blue® Select are available year-round and do not have an annual open enrollment period. Dental Blue® Plus has an initial open enrollment period that begins October 1, 2013 and extends through March 31, 2014. If you do not enroll during this initial open enrollment period, you may enroll during the plan’s next open enrollment period.

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Three easy ways to enroll Online: Get more information or enroll online at www.ibcbsal.com/dental.

Through the mail: Fill out and mail in your paper application.

On the phone: Talk to an Insurance Advisor or to meet with a sales representative, call 1-855-890-7416.

Have questions about our plans or need help enrolling? Call us toll free at 1-855-890-7416. Did you know? Visit us anytime at www.ibcbsal.com/dental.

50% of people consider the smile the first facial feature they notice.

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Proudly serving Alabamians — since 1936 Blue Cross and Blue Shield of Alabama has been providing access to quality coverage and dependable, local service for over 75 years. Our commitment to providing products of value extends to millions of Alabamians. As a member of the Blue Cross and Blue Shield of Alabama family, you can count on us to be there when you need us. We look forward to bringing you the peace of mind you want in a dental plan and the service excellence you deserve.

Visit us anytime at www.ibcbsal.com/dental.

Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association.

MKT-622 (Rev. 8-2013)

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