Learn more about BCBS FEP Dental plan benefits and premiums. Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2022- 12/31/2022 Anthem Blue Cross: PORAC Prudent Buyer PPO Plan Coverage for: Individual + Family | Plan Type: PPO CA/L/A/CalPERS PPOC20800:PORACPrudentBuy-PPO/NA/UQBHJ/NA/01-22 1 Traditional insurance offers the most freedom of choice and control over healthcare, but benefits are maximized when using a participating Blue Cross Blue Shield company. The site may also contain non-Medicare related information. 15 49 The deductible is usually a set amount or percentage determined by the members contract and is set for a given period of time. You pay 50% after deductible before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. You are about to leave Blue Cross and Blue Shield of Alabama's website and enter a website operated by HealthEquity. In addition, some sites may require you to agree to their terms of use and privacy policy. 0000005327 00000 n Individuals attempting unauthorized access will be prosecuted. Our health plan advisors can help you choose a plan, calculate your costs and tell you whether you're eligible for a subsidy. The three dental plans for children on Medicaid are: Dentaquest, MCNA Dental and UnitedHealthcare Dental. 0000088585 00000 n Box 986030, Boston, MA 02298. The evaluation of health questionnaires submitted by all proposed plan members to determine the overall insurability of the group. Bridges and dentures 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). TTY users dial 711. Blue Cross Blue Shield awards this designation to medical facilities that have demonstrated expertise in delivering quality healthcare in the areas of: bariatric surgery, cardiac care, complex and rare cancers, spine surgery, transplants and knee and hip replacement. They are not balance billed Network providers will not bill for costs that are in excess of the BCBSTX allowable amount for covered services. 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. 0000055048 00000 n 0000107816 00000 n Alberta. Outside the United States. Oral health touches every aspect of our lives but is often taken for granted. 44 79 Members can find information aboutagent commissions. 0000070270 00000 n Now you can supplement your benefits with Accident, Critical Illness, and Hospital Recovery plans. A document that provides background information about various underwriting impairments and suggests the appropriate action to take if such impairments exist. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Addresses the health and lifestyle needs of consumers through unique partnerships and experiences designed exclusively for Blue365 members. 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. Posted: Apr 25, 2023 / 03:27 PM CDT. As a member of Blue Cross Blue Shield FEP Dental, we aim to provide the highest level of service available. 0000014575 00000 n If you are a BCBSIL member and have questions about your health care plan benefits, check with your group benefits administrator or contact Customer Service at the number listed on your BCBSIL member ID card. Call your child's Medicaid dental plan to learn more about the dental services they offer. 0000013821 00000 n Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross . Get access to your agent portal.Register Now. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association NOT FOR DISTRIBUTION TO BENEFICIARIES, MEMBERS, OR PROSPECTS BlueCare Dental Classic Plans 1,2 BlueCare Dental Classic plans cover only one person per policy. 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BCBSIL and go2dental.com are separate companies. Learn more about dental services for adult STAR members. Call us at1-855-237-3501. 0000010274 00000 n An evaluation of the medical necessity, appropriateness and cost-effectiveness of healthcare services and treatment plans for a given patient. Cleanings are covered three times a year. For more information on specific coverage you can contact customer service. 0000022849 00000 n 0000011502 00000 n The direct care provider is in the same physical location as the member and offers care to patients from within the local Plan's service area. Acrobat Distiller 11.0 (Windows) Updated: Apr 25, 2023 / 04:24 PM CDT. 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$ldXaC]Z-2mJutPtX1nVXc "h|e2e4"*D=I Limitations and Exclusions Exclusions Dependent coverage Unmarried dependent children are covered under age 26 or under age 30 if a military veteran. A national data capability derived from Blue Cross Blue Shield companies' collective provider networks and membership. 0000139581 00000 n Also known as prior authorization. T9"TaS~mMeOL2Xi$HS#f8eN@PW :V 5nw_qTKRPHKj:rfYqb7u/l&9T5oku`!r[Wsv^t';/#3B^>`BlHj\vu$8JaaJt\#+h1%Dj-M*9=>G@i[f>H!3nC1*kjytKuT8dF z|/ yA'#G*'zY6#a)8FXwTs;K:q*i97O|yr,f9+:BMg/tY6x43rXN^r>9sDGLt7A3RCsJ%s m7 Visit www.bcbsmt.com/member 2. Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. 0000076479 00000 n A health maintenance organization (HMO) that contracts with multiple group practices of physicians or specialty groups. 0000059102 00000 n Covered once per tooth per lifetime. Your child's Medicaid dental plan provides dental services including services that help prevent tooth decay and services that fix dental problems. The Medicare component that provides benefits to cover the costs of physicians' professional services, whether the services are provided in a hospital, a physician's office, an extended-care facility, a nursing home or an insured's home. Traditional insurance, also known as Indemnity or Fee-for-Service, allows members to select any healthcare provider for services. Blue Access for Members SM(BAM SM) The gateway to help manage your personal health information. BlueCard applies if the provider of service is outside the member's Blue Cross Blue Shield Plan's service area and does not contract with the member's Plan. Fully-Insured Small Group Summary of Dental Benefits. A free-standing center that performs various types of surgery. All Canada. 0000036033 00000 n Your employer should be able to provide a benefit booklet for you which will provide some details of your coverage. The BlueCare Dental PPO product is a product available for purchase on a self-funded basis only. Box 551, Minneapolis, MN 55440-0551. Copyright 2022Health Care Service Corporation. 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. The content on the Dental Wellness Center website is provided by go2dental.com, Inc. (go2dental.com). Fillings Note: There will be no changes to coverage and claims details for existing Blue Choice plan holders following the new Health and Dental launch on . Up to $800 of the $1,200 in-network total can be used toward out-of-network care. For personal medical guidance, please consult your dentist and/or physician. If you have any questions or comments regarding the Dental Wellness Center website, you should direct them to go2dental.com, Blue Cross and Blue Shield of Illinois, 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). If a member . See the chart on the back for more plan details. 0000080580 00000 n A set of specialized healthcare services that provide support to terminally ill patients and their families. These documents also show your estimated costs for two sample medical events: having a baby and managing diabetes. Maximum dollar amounts set by MCOs (managed care organizations) that limit the total amount the plan must pay for all healthcare services provided to a subscriber per year or in his/her lifetime. 0000001276 00000 n IV. 0000002644 00000 n BCBS FEP Dental is here to help you learn more about your oral health. Register Now, Not registered? Access theDental Wellness Center. Members choose in-network care or out-of-network care at the time they make their dental appointment and usually incur higher out-of-pocket costs for out-of-network care. There are three ways to enroll in BlueCare Dental PPO: Select 'YES' next to the Dental option when you apply online for any qualifying Blue Cross and Blue Shield of Texas health plan. Periodontal maintenance BlueCare Dental is a portfolio of standard dental preferred provider option (PPO) benefit plan designs BlueCare Dental Freedom SM and BlueCare Dental Choice SM. For more information, please contact your account executive at 1-505-837-8787 or toll-free at 1-800-672-9700. 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. If you're considering enrolling in one of our individual and family plans, learn a bit more about the coverage you'll receive. Get access to your online account. 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). 2020-09-09T21:17:19-07:00 0000007922 00000 n 0000028804 00000 n Not registered? We will cover all overseas services at the in-network level for all members. This includes services the doctor provides and other services your child might need like anesthesia. Dental PPO plans are available to both insured and administrative services only (ASO) accounts. Provider Finder from Blue Cross and Blue Shield of Texas (BCBSTX) is a fast, easy-to-use tool that improves member experience when theyre looking for in-network health care providers. If you are calling from April 1 through September 30, Select Blue Cross Blue Shield Global or GeoBlue if you have international coverage and need to find care outside the United States. 2020-09-09T21:17:19-07:00 Plus, it can help them manage their out-of-pocket costs. It is focused on preventive care and the treatment of routine injuries and illnesses. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. 3. pdent blue cross coverage. 0000001876 00000 n 0000035717 00000 n A voluntary health insurance program for federal employees, retirees and their dependents and survivors. Your employer should be able to provide a benefit booklet for you which will provide some details of your coverage. 2900 Ames Crossing Road ; Eagan, MN 55121 1-800-693-6703 . 0000139770 00000 n One option is Adobe Reader which has a built-in reader. External link You are leaving this website/app (site). The MCO (managed care organization) committee that evaluates proposed policies and action plans related to clinical practice management, including changes in provider contracts, compensation and changes in authorization procedures. This drug list is updated monthly. Fillings Check out our FAQs page to get answers to questions, or Contact Us with any questions you may have. 0000014199 00000 n The provision of mental health and chemical dependency (or substance abuse) services. uuid:63d11d8f-8f4f-474a-a014-6ba0ac5e1aeb Most PDF readers are a free download. Coverage for treatments varies depending on the member's benefit plan. There is no waiting period for Class I services. The PPO dental plan provides a higher level of benefits when members receive treatment from BlueCare Dental participating providers. Treatment that is provided to a patient who is able to return home after care without an overnight stay in a hospital or other inpatient facility. Federal Programs. BlueCare Dental Connectionis a program benefit that provides members with education and intervention through support tools and educational mailings. Allowed amount The contracted rate, or "Blue Cross discount," set by your plan and providers when you see in-network hospital, clinics or pharmacies . The health plan physician executive who is responsible for the quality and cost-effectiveness of the medical care delivered by the plan's providers. It is often proven by eliminating other diseases and possibilities. The member's location at the time of service is irrelevant. 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. Groups with 151+ Employees Space maintainers are covered once per quadrant every two years for members to the end of the month of their 15th birthday. Once youve reached this out-of-pocket maximum, your plan pays 100 percent of the allowed amount. One option is Adobe Reader which has a built-in reader. Ue-f}zM^+r5{dV9KfK.K.K.#Q6zzz=^W+kta8e6E6e6Eldtdx$LNp9- endstream endobj 27 0 obj <> endobj 28 0 obj <>stream 0000041318 00000 n But you'll pay less if you see a Tier 1 PPOin-network dentist. Adult members are age 19 or older at the start of the coverage year. Get access to your provider portal. The network comprising those physicians, hospitals and other healthcare providers PPO members may elect to use to obtain the highest level of PPO benefits. There is a deductible for Class II and III services only. Standard Option members already receive this benefit. hb``b``f`c`pjed@ AV(7{`SopLY-}Piii@ 1)ix`)b}$?G^9[+ 0 fsLRG&c{\.p6^gW||g$k%X86X H36 5 endstream endobj 16 0 obj <>>> endobj 17 0 obj >/PageUIDList<0 218>>/PageWidthList<0 612.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/Properties<>/Shading<>>>/Rotate 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 18 0 obj <>stream Often the patient and the indirect care provider are in different physical locations. External link You are leaving this website/app (site). hb```e`` l@Q>l e I#r^ 0000015127 00000 n IyaPC96>$i}KFVLWEs$g;iQrij:J]#b]Fd`0c;TU\5ZXyZbb{l I6Be6i^f+viqy .px8~N Questions? In addition, some sites may require you to agree to their terms of use and privacy policy. Limited to three times a year in combination with routine cleaning. contact your local Blue Cross Blue Shield company. Calling BlueCard Eligibility will facilitate efficient payment for the provider. 0000004259 00000 n An information system that incorporates membership data and provider reimbursement arrangements and analyzes transactions according to contract rules. ;m* The services covered include: Teeth cleanings. Refers to any Blue Cross and/or Blue Shield Plan. 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. Fluoride treatments are covered twice a year for members to the end of the month of their 19th birthday. To give you an accurate price, we'll need some information. %PDF-1.6 % takes the health and well-being of our members, providers, our associates and our business partners seriously. The practice of an insurance company underwriting a number of small groups as if they constituted one large group. 0000002464 00000 n Call us at (312) 726-6565 Benefits & Rates 0000029289 00000 n Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. For travellers, the app is the fastest way to buy and manage Canada's most trusted brand in travel insurance. 0000002422 00000 n 0000003305 00000 n Bitewing X-rays Site Map|Feedback|Download Adobe Acrobat Reader, Learn more about a Healthier Michigan.org, Glossary of Health Coverage and Medical Terms, Important Information About Medicare Plans. The application of managed care principles (techniques to reduce costs and improve quality of heallthcare) to 24-hour coverage. After a 12-month waiting period, cover is extended to major procedures including dentures, implants, crowns and orthodontics - all subject to an annual maximum of $1,500. An employer that has offices or branches in more than one location, but offers uniform healthcare coverage of benefits to all of its employees. The content on the Dental Wellness Center website is provided by go2dental.com. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. Blue Cross Blue Shield Global Current Members 0000055326 00000 n All member-submitted claims must be received within two years of the date of service. Limited to twice a year in combination with routine cleaning. H\n0E See also precertification. 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). Ottawa. %PDF-1.4 % Blue Cross and Blue Shield of Texas (BCBSTX) covers emergency dental services your child gets in a hospital or ambulatory surgical center. 0000041754 00000 n The three characters preceding the subscriber identification number on BCBS member ID cards. Please note, this is a summary of features of Blue Cross Blue Shield FEP . The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. Adult BCBSTX STAR members aged 21 and older are eligible to receive dental services as a Value-Added Services. endstream endobj 45 0 obj <> endobj 46 0 obj <> endobj 47 0 obj <> endobj 48 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageB]/XObject<>>> endobj 49 0 obj <> endobj 50 0 obj <> endobj 51 0 obj <> endobj 52 0 obj <> endobj 53 0 obj <> endobj 54 0 obj <> endobj 55 0 obj <> endobj 56 0 obj <> endobj 57 0 obj <> endobj 58 0 obj <> endobj 59 0 obj <> endobj 60 0 obj <> endobj 61 0 obj <> endobj 62 0 obj <> endobj 63 0 obj <> endobj 64 0 obj <> endobj 65 0 obj <>stream Many people losing their Medicaid coverage will be eligible for financial help to pay for healthcare and some could be eligible for a $0 monthly premium plan. Limited to once every 24 months for primary teeth, and once every 48 months for permanent teeth. Refer to this list for drug coverage information for Blue Cross members whose plan uses the Custom Select Drug List. With the Premium plan preventive care is free and after 6 months the co-payment for fillings and simple extractions is just 20%. Blue Distinction Centers for Specialty Care, Need to Make a Payment? Blue ShieldFEP Dental's value and offerings. Need help understanding and choosing a benefit plan? PDENT is your dental plan. Your coinsurance is your share of the costs of a service. Enables members to receive healthcare services wherever they live or travel, nationally or internationally. The website lets members log daily activities and track progress over time. A federal law that outlines the requirements that employer-sponsored group insurance plans, insurance companies and managed care organizations must satisfy in order to provide health insurance coverage to individuals and groups. Overview Adult Dental Pediatric Dental Overview About this plan %?Mf_A_a_A_a_A_a_A_e_E_YpV:+ Call Dentaquest at 1-800-516-0165, MCNA Dental at 1-800-494-6262 or UnitedHealthcare Dental at 1-800-822-5353. General medical care that is provided directly to a patient without referral from another physician.