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Dental Plans for Individuals & Families AlabamaBlue.com/dental b l ue cro s s Covering what MATTERS Blue Cross and Blue Shield of Alabama offers qua...
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Dental Plans for Individuals & Families AlabamaBlue.com/dental

b l ue cro s s Covering what MATTERS Blue Cross and Blue Shield of Alabama offers quality and affordable individual and family dental plans.

Are you looking for only dental coverage? Do you already have a health plan and would like to add dental coverage? Whatever your needs may be — we cover what matters. EXPERTISE

For more than 79 years, Blue Cross and Blue Shield of Alabama has been providing access to quality coverage and dependable, local service. Our commitment to providing products of value extends to millions of Alabamians. ACCESS TO CARE

You have access to a comprehensive network of more than 1,600 dental providers in Alabama. SERVICE

As a member of the Blue Cross family, you can count on us to be there when you need us. Our superior 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 member ID card, you carry peace of mind in your pocket. You can depend on Blue Cross. It’s a brand that is respected throughout Alabama.

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 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.

HOW TO ENROLL

• Go to AlabamaBlue.com/dental. • Call 1-855-204-4729 to talk with an Insurance Advisor. • To request a paper application, call an Insurance Advisor at the number above. WHO IS ELIGIBLE FOR COVERAGE?

To be eligible for Dental Blue or Dental Blue Select, you must be: v A resident of Alabama v At least 19 years of age or older To be eligible for Dental Blue Plus, you must be a resident of Alabama. There are no age restrictions.

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CHOOSE the dental plan that’s best for you and your family

Our standard dental plan covers basic benefits such as regular dental exams, x-rays and cleanings.

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

Our dental plan that features expanded pediatric dental benefits for children up to the end of the month in which the member turns 19. This plan is available only at HealthCare.gov.

COMPARE coverage highlights MONTHLY PREMIUMS

Dental Blue

Dental Blue Select

Self v

$21

$32

Self plus one v

$42

$66

Family v

$75

$129

Adult (Age 19+)= $23 Child (through age 18)= $33

Calendar Year Deductible

$50 per person

$50 per person

$40 per person

Calendar Year Maximum Benefits

$1,000 per person

$1,500 per person

$1,000 per person (age 19 and over)

No maximum for children up to age 19*

Not applicable

Not applicable

$350 (one child up to age 19*)

$700 (two or more children up to age 19*)

(The most we will pay each year)

Pediatric Out-of-Pocket Maximum (The most you will pay each year)

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Dental Blue Plus

COVERED BENEFITS** After you meet your deductible: Diagnostic and Preventive Services ~ No waiting period • Dental exams & x-rays • Routine cleanings

Dental Blue

Dental Blue Select

Dental Blue Plus

YOU PAY

WE PAY

YOU PAY

WE PAY

YOU PAY

WE PAY

$0

100%

$0

100%

$0

100%

25%

75%

20%

80%

20%

80%

50%

50%

50%

50%

50%

50%

50%

50%

50%*

50%*

60%

40%

after you meet a $150 orthodontic deductible

after you meet a $150 orthodontic deductible

Basic Services † • Fillings • Simple tooth extractions • Root canal (non-surgical) • Emergency treatment for pain • Repairs to crowns and dentures (fixed partials and removable) Major Services †† • Oral surgery • General anesthesia • Periodontic exams • Removal of diseased tissues and bones Additional Major Services †† • Crown, inlays, onlays and dentures

Not covered

Orthodontic Services†† • Coverage for children* • Limited to a lifetime maximum of $1,500***

Not covered

50%

50%

after you meet a $150 orthodontic deductible when deemed medically necessary

after you meet a $150 orthodontic deductible when deemed medically necessary

* This benefit is only available up to the end of the month in which the member turns 19.

** Benefits listed apply to in-network services.

*** The lifetime maximum only applies to Dental Blue Select.



180-day waiting period applies. (This waiting period does not apply to members up to the end of the month in which the member turns 19, enrolled in Dental Blue Plus.) †† 365-day waiting period applies. (This waiting period does not apply to members up to the end of the month in which the member turns 19, enrolled in Dental Blue Plus. Dental Blue Plus members have a 24-month waiting period up to the end of the month in which the member turns 19 for medically necessary orthodontic services.)

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Commonly asked QUESTIONS Do I need to have a Blue Cross health plan to purchase a dental plan?

No, our plans are dental-only plans for individuals and families. No matter what type of health coverage you have, you can enjoy Blue Cross dental coverage.

How do I pay?

You may pay your monthly premium by eCheck, check, credit or debit card (Discover®, MasterCard® or Visa®). 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 medically necessary orthodontic services.

What are “medically necessary orthodontic services”?

Medically 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.

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k e ep yo ur sm i l e heal thy by enrolling in a DENTAL PLAN today

THREE EASY WAYS to enroll

ONLINE

Go to AlabamaBlue.com/dental.

ON THE PHONE

To talk to an Insurance Advisor, call 1-855-204-4729.

BY MAIL

To request a paper application, call an Insurance Advisor at the number above.

Have questions about our plans or need help enrolling? Call us at 1-855-204-4729 Visit us anytime at AlabamaBlue.com/dental

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450 Riverchase Parkway East P.O. Box 995 Birmingham, Alabama 35298-0001

Proudly serving Alabamians SINCE 1936 B l u e C r o s s a n d B l u e S h i e l d o f A l a b a m a has been providing access to quality coverage

and dependable, local service for more than 79 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, y o u c a n c o u n t o n u s t o b e t h e r e w h e n y o u n e e d u s . 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 AlabamaBlue.com/dental DEN-S16 (7-2015)

An Independent Licensee of the Blue Cross and Blue Shield Association

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