PLAN
NETWORK
Value Certified |
|||
|---|---|---|---|
| Benefits | |||
| Deductible (per adult member each year)1 | $0 | ||
| Deductible (per member under 21 per calendar year)1 | $50 | ||
| Adult benefit maximum per year - members age 21 and older | $500 | ||
| Child benefit maximum per year - members under age 21 | Unlimited | ||
| Child out-of-pocket yearly maximum - members under age 21 |
$350 for 1 Child $700 for 2 or more Children |
||
| Child2 No Waiting Period | Adult | Adult Waiting Period | |
| Routine Oral Exams and Cleanings1 | 100% | 100% | None |
| Oral X-Rays1 | 100% | 100% | None |
| Fluoride Treatments1, Sealants1 | 100% | Not Covered | Not Covered |
| Palliative Treatment (Emergency)1 | 100% | 100% | None |
| Basic Restorative (Amalgam, Resin Fillings), Endodontics | 80% | 60% | None |
| Oral Surgery, Surgical Extractions | 80% | 60% | None |
| Simple Extractions | 80% | 60% | None |
| Periodontics - Surgical and Non-Surgical | 80% | Not Covered | Not Covered |
| Crown Repairs | 80% | Not Covered | Not Covered |
| Crowns and Prosthetics (Bridges, Dentures) | 50% | Not Covered | Not Covered |
| Implants - Must meet Dental Necessity Requirements | 50% | Not Covered | Not Covered |
| Orthodontics (Members Under Age 21 Only) | |||
| Medically Necessary | 50% | Not Covered | Not Covered |
| 1Does not apply to diagnostic and preventive services | |||
| 2Members under age 21. Certain benefits are limited to children younger than 18. | |||
| See contract and schedule of benefits for coverage exclusions and limitations | |||
| To take full advantage of your Blue Dental coverage, choose a dentist who participates in the Advantage Plus network.* Dentists in the Advantage Plus network provide covered services at a significant savings. |
|||
| *Advantage Plus Network is administered by United Concordia Companies, Inc. United Concordia is an independent company that administers dental benefits on behalf of Blue Cross and Blue Shield of Louisiana. | |||
We're sorry, something went wrong! Please refresh your browser and try again.