c< Pacific Blue Cross has available coverage for health, dental and emergency medical travel. Sealants Patients and Blue Cross Blue Shield Arizona members can contact Blue Cross Blue Shield Arizona or its affiliated health plan using the phone number on the back of their insurance card with questions or reach out to memberhelp@azblue.com. Up to $800 of the $1,200 in-network total can be used toward out-of-network care. 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. Questions? A benefit payment system in which an insurer reimburses the group member or pays the provider directly for each covered medical expense after the expense has been incurred. 0000069906 00000 n Cleanings are covered twice a year. 0000041754 00000 n 0000013821 00000 n Periodontal maintenance A medical care center that provides a wide range of healthcare services, including preventive care, acute care, surgery and outpatient care, in a centralized facility. Your child's Medicaid dental plan provides dental services including services that help prevent tooth decay and services that fix dental problems. A utilization management technique that requires a healthcare insurance plan member or the physician in charge of the member's care to notify the plan, in advance, of plans for a patient to undergo a course of care such as a hospital admission or complex diagnostic test. 0000062841 00000 n The Blue Cross Blue Shield Grievance Most PDF readers are a free download. A value-added discount program that provides Blue Cross and Blue Shield members with discounts and content on health and wellness, family care, financial services and healthy travel . 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. This includes services the doctor provides and other services your child might need like anesthesia. Complete dentures covered once per arch every 84 months; partial dentures and bridges covered once per arch every 84 months for members age 16 and older. You are about to leave Blue Cross and Blue Shield of Alabama's website and enter a website operated by HealthEquity. p ?P\H19y+_Q /iY.Q6?/??h= $Ng3,M;Tz\LJhzs"N@?XGGy*& b 0000041318 00000 n A doctor, hospital or other healthcare entity enrolled in a network of designated PPO providers. Space maintainers are covered once per quadrant every two years for members to the end of the month of their 15th birthday. A large pool of individuals for which health coverage is provided by the group sponsor. These budget-friendly insurance options help lessen the financial impact of unexpected health care costs. See the chart on the back for more plan details. With BlueCare Dental PPO, you'll get: One of the highest maximum annual benefit levels available - up to $1,500 per person per year Up to a 20% discount, up to a maximum savings of $1,000 for orthodontic services at participating dentists For more information on coverage and benefits, view the BlueCare Dental Outline of Coverage Although the size limit of each MCO (managed care organization) may vary, a small group generally refers to a group containing at least two and less than a hundred members for which health coverage is provided by the group sponsor. Use our Find a Provider tool to The website lets members log daily activities and track progress over time. For more information on specific coverage you can contact customer service. This new site may be offered by a vendor or an independent third party. PScript5.dll Version 5.2.2 Ue-f}zM^+r5{dV9KfK.K.K.#Q6zzz=^W+kta8e6E6e6Eldtdx$LNp9- endstream endobj 27 0 obj <> endobj 28 0 obj <>stream 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 <. As a member of Blue Cross Blue Shield FEP Dental, we aim to provide the highest level of service available. 0000006903 00000 n Also known as drug cards or prescription cards. A cost containment program that recovers money for healthcare where primary responsibility does not exist because of another group health plan or contractual exclusions. 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. Keep in mind they aren't based on actual prices. A large group may be defined as more than 250, 500, 1,000, or some other number of members, depending on the managed care organization. 0000050349 00000 n To access your member services, please visit your BCBS company. Carries an ID card with this identifier on it. You pay50%after deductible before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. A toll-free number, 1-800-676-BLUE, for healthcare providers to verify Blue Cross Blue Shield membership and coverage information for patients. Your coinsurance is your share of the costs of a service. We use cookies to ensure that we give you the best experience on our website. Blue Cross Blue Shield FEP Dental 0000006103 00000 n Visits are covered twice a year. 211 Canada. PPO. Call us at (312) 726-6565 Benefits & Rates To view this file, you may need to install a PDF reader program. These cards assist PBMs in processing and tracking pharmaceutical claims. One option is Adobe Reader which has a built-in reader. Periodontal maintenance You can watchthis videoto meet your health plan advisors. %PDF-1.6 % Need help understanding and choosing a benefit plan? A dental service plan that allows a member to use either a dental health maintenance organizations (DHMO) network dentist or to seek care from a dentist not in the health maintenance organization's (HMO) network. The examples are meant to help you understand what you might pay, and compare that to other plans. These services are covered 12 months after you first join a Blue Dental plan. 0000002793 00000 n Most PDF readers are a free download. TTY users dial 711. 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. All Rights Reserved. The practice of an insurance company underwriting a number of small groups as if they constituted one large group. 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. To find your premium, locate your state and/or zip code in the rating area table below and to identify your rating area. During this unprecedented time, we're taking action to support our members. 0000005327 00000 n 0000011650 00000 n Also known as a medical-necessity review. To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. Check out our Member Education Materials to get more information aboutBlue Cross T9"TaS~mMeOL2Xi$HS#f8eN@PW :V 5nw_qTKRPHKj:rfYqb7u/l&9T5oku`!r[Wsv^t';/#3B^>`BlHj\vu$8JaaJt\#+h1%Dj-M*9=>G@i[f>H!3nC1*kjytKuT8dF z|/ yA'#G*'zY6#a)8FXwTs;K:q*i97O|yr,f9+:BMg/tY6x43rXN^r>9sDGLt7A3RCsJ%s m7 A utilization and quality management mechanism designed to aid providers in making decisions about the most appropriate course of treatment for a specific clinical case. H\n0. There is no need to submit a paper claim. BlueCare Dental HMO offers a dental network that is one of the largest in Illinois. 2900 Ames Crossing Road ; Eagan, MN 55121 1-800-693-6703 . A process through which an organization validates credentialing information from the organization that originally conferred or issued the credentialing element to the practitioner. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. A Medicare supplement that uses a preferred provider organization (PPO) to supplement Medicare Part B coverage. Your employer should be able to provide a benefit booklet for you which will provide some details of your coverage. 0000003118 00000 n =%V|'55KkW|_N&W4to;6ydLHO9;, mZ7mqDe"^=M'K#qFNHMDVx,>:'e ;>7o)rl-aX9]*E@l;Pz{XnGAc[=l V p\Z#'3WIHm"qq&.Sw76c\}oSm+qrA[Eg>95?Zqe"2//bZ^2OT FI"bT$.q+ Rz?>tFZm^-S~t;.3&lL5fFf$=u|A8P3*XK2Ex`Kd5.-Wy?N/e>622H#/r=$Ct^;lcEK v-wsmRT3X"/\{ D 0 0000088585 00000 n 0000006015 00000 n 0000003587 00000 n Register Now. A summary of benefits and coverage explains things like what a health insurance plan covers, what it doesn't cover, and what your share of costs will be. 0000004259 00000 n It's usually figured as a percentage of the amount we allow to be charged for services. 0000080580 00000 n 0000008069 00000 n A summary of benefits and coverage explains things like what a health insurance plan covers, what it doesn't cover, and what your share of costs will be. Register Now, Not registered? In addition, some sites may require you to agree to their terms of use and privacy policy. 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. 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. (Coverage is not available for non-network dentists in Massachusetts except for covered emergency services.) Covered once per tooth every 60 months. You are leaving this website/app (site). 0000047131 00000 n A document that provides background information about various underwriting impairments and suggests the appropriate action to take if such impairments exist. If the member elects to receive care from BlueCare Dental network providers: If the member elects to receive care from providers outside of the network, they may choose: In addition, members have access to the BlueCare Dental ConnectionSMprogram. Need help understanding and choosing a benefit plan? This includes services the doctor provides and other services your child might need like anesthesia. This out-of-pocket maximum is the most youll have to pay during a calendar year for covered pediatric dental services. 0000097745 00000 n You may also ask us for a coverage determination by phone at 1-888-285-2249 (TTY:711), We are open 8 a.m. - 8 p.m., local time, 7 days a week. BlueCare Dental ConnectionSM is a program benefit that provides members with education and intervention through support tools and educational mailings. Learn more about dental services for adult STAR members, 8 a.m. to 5 p.m. Central Time Monday through Friday. These documents also show your estimated costs for two sample medical events: having a baby and managing diabetes. 0000063121 00000 n June 17, 2022 . Table of Contents. Blue Cross and Blue Shield of Texas (BCBSTX) covers emergency dental services your child gets in a hospital or ambulatory surgical center. 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 1 122 0 obj <>stream Important Legal and Privacy Information|Important Information About Medicare Plans|Privacy Practices Go Paperless: Choose to receive paperless Explanation of Benefits (EOB) and other policy documents Registering for your BAM account is easy 1. <<73BE20F0500195428ED66B90D75311C9>]/Prev 113554>> The three characters preceding the subscriber identification number on BCBS member ID cards. %?Mf_A_a_A_a_A_a_A_e_E_YpV:+ An organization that provides dental services through a network of providers to its members in exchange for some form of prepayment. 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. 100% coverage for periodontal cleanings to members with specific health issues at no additional cost. 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. 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). Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. Scroll. 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. 0000014575 00000 n 44 79 Members receive a higher level of benefits when they use in-network providers than if they use out-of-network providers. 0000010545 00000 n 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). Not Registered? HealthEquity has . 2020-09-09T21:17:19-07:00 Our AskBlue SM BCBS FEP Dental Plan Finder tool can help you select the right plan for your needs. Federal Programs. 0000050040 00000 n There is no waiting period for Class I services. endstream endobj 66 0 obj <> endobj 67 0 obj <>stream 0000049503 00000 n State and Federal Privacy laws prohibit unauthorized access to Member's private information. Individuals attempting unauthorized access will be prosecuted. 0000000016 00000 n 0000024004 00000 n BlueCare Dental is a portfolio of standard dental preferred provider option (PPO) benefit plan designs BlueCare Dental Freedom SM and BlueCare Dental Choice SM. benefits, keeping your smile healthy and protecting your overall health. 4VOCevR%M"|~GHI84SRhX/ Dependent coverage Unmarried dependent children are covered under age 26 or under age 30 if a military veteran. An application for payment of benefits under a health plan. 0000006502 00000 n The integration of financing and delivery of healthcare within a system that seeks to manage the accessibility, cost and quality of that care. 0000012877 00000 n 0000029289 00000 n Also known as disease state management. Refer to this list for drug coverage information for Blue Cross members whose plan uses the Custom Select Drug List. Blue Cross Blue Shield of Massachusetts, P.O. The site may also contain non-Medicare related information. Get access to your agent portal. What are the side effects of Thiazolidnedions. Identification cards issued by a pharmacy benefit management plan (PBM) to plan members. Alberta. A specified dollar amount that a member must pay out-of-pocket for a specified service at the time the service is rendered. * Blue Cross and Blue Shield of Illinois (BCBSIL) is providing access to the Dental Wellness Center website as a courtesy, as part of its BlueCare Dental Connection program. /E!{"I+e1m5 Ni!V4H b~G}.5]W=7)Rxk[L9S7)cb?4 01=G35`{uio)}li.\ Ne:~Mo)ccpsYSG#xE^-x9L)qEK,duLGJNek. 0000021620 00000 n Blue Access for Members SM(BAM SM) The gateway to help manage your personal health information. See specialty health maintenance organization. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred. 0000107816 00000 n This new site may be offered by a vendor or an independent third party. 0000005826 00000 n Does Blue Cross and blue shield of Texas (bcbstx) have a dental Wellness 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. 0000069257 00000 n Contact Pacific Blue Cross for more information or to speak with one of our Service Representatives: Individual Plans Sales and Support Telephone: 604 419 2000 Fax: 604 419 2199 Email: inhealth@pac.bluecross.ca Toll-free Outside the Greater Vancouver Area: Fluoride treatments Call Dentaquest at 1-800-516-0165, MCNA Dental at 1-800-494-6262 or UnitedHealthcare Dental at 1-800-822-5353. 0000046006 00000 n For more detailed information on the plan designs available, covered benefits, services and supplies that are limited or excluded, general administration of the plan, or any other questions you may have regarding our products and services, please contact your account representative for the phone number of the regional sales office near you. Blue Cross Blue Shield Global Current Members Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. Covered once per tooth per lifetime. Anthem's medical plans offer healthcare coverage you and your family can rely on. It is only available under an insured funding arrangement for groups sized 51 or more lives. 0000059838 00000 n The Pacific Blue Cross Mobile app helps you manage your benefits and improve the health & wellbeing of you and your family. Limited to three times a year in combination with routine cleaning. In addition, some sites may require you to agree to their terms of use and privacy policy. 0000035717 00000 n and Prevention (CDC), and state and local public health departments. Members fund their FSAs with contributions that come out of their paycheck. Choose from a variety of affordable group health plans to fit the needs of your employees and your business. The BlueCare Dental PPO product is a product available for purchase on a self-funded basis only. For all of your dental questions and/or claim forms, please contact your local Blue Cross Blue Shield company. 0000000016 00000 n 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. An evaluation of the medical necessity, appropriateness and cost-effectiveness of healthcare services and treatment plans for a given patient. BlueCard Access assists members who need a referral to a physician or healthcare facility in another location. 0000001876 00000 n A contract provision, included in all standard provider contracts, that allows either the MCO (managed care organization) or the provider to terminate the contract when the other party does not live up to its contractual obligations. Established by the Balanced Budget Act, this program is designed to provide health assistance to uninsured, low-income children either through separate programs or through expanded eligibility under state Medicaid programs. The services covered include: Teeth cleanings. 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. Allows members to save money into tax-advantaged accounts. 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. 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. 0000028804 00000 n Copyright 2022Health Care Service Corporation. Also known as preventive care programs or wellness programs. 0000004772 00000 n Only members with this identifier can access the benefits of BlueCard PPO. We will work with and follow all COVID-19 guidance and protocols provided by the Centers for Disease Control For all of your dental questions and/or claim forms, please contact your local Blue Cross Blue Shield company. Class IV services are not covered. The application of managed care principles (techniques to reduce costs and improve quality of heallthcare) to 24-hour coverage. 0000005663 00000 n Services may be provided from a single site or from multiple locations. Dollar amounts set by MCOs (managed care organizations) that limit the amount a member has to pay out of his/her own pocket for particular healthcare services during a particular time period. Accounts that employers can establish for employees to reimburse a portion of their eligible family members' out-of-pocket medical expenses, such as deductibles, coinsurance and pharmacy expenses. locate a dentist in the BCBS FEP Dental network or call us at 1-855-504-2583 for assistance. 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. They are not balance billed Network providers will not bill for costs that are in excess of the BCBSTX allowable amount for covered services. Blue Cross and Blue Shield of Texas (BCBSTX) covers emergency dental services your child gets in a hospital or ambulatory surgical center. With BlueCare Dental PPO, members have the option to receive care from dentists who are not in the network. 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. 0000009480 00000 n Covered once per tooth per lifetime. A coordinated system of preventive, diagnostic and therapeutic measures intended to provide cost-effective, quality healthcare for a patient population who have or are at risk for a specific chronic illness or medical condition. The name Affordable Care Act refers to the final, amended version of the law. The process of obtaining all the information necessary to determine the appropriate amount to pay on a given claim. 0000006747 00000 n President of Blue Cross and Blue Shield of Texas The Dental Schedule of Coverage enclosed with this Benefit Booklet indicates benefit percentages, Deductibles, maximums, and other benefit and payment issues that apply to the Plan. Also known as a chief medical officer. 0000041603 00000 n Fully-Insured Small Group Summary of Dental Benefits. Limited to once every 24 months for primary teeth, and once every 48 months for permanent teeth. If you have further questions, call Customer Service at 1-855-504-2583 in the U.S. or 1-651-994-2583 0000034533 00000 n Includes coordination of benefits, Workers' Compensation, subrogation and no-fault auto insurance. 0000107561 00000 n Also known as prior authorization. The network comprising those physicians, hospitals and other healthcare providers PPO members may elect to use to obtain the highest level of PPO benefits. 0000007922 00000 n Use ourProvider Finderto search for doctors and pharmacies near you. All member-submitted claims must be received within two years of the date of service. Temporomandibular Joint Disorder (also known as TMJ, TMD, or TMJD) is also a disease that medical insurance carriers still question. trailer This new site may be offered by a vendor or an independent third party. Learn more about eligibility and resources for uniformed service members transitioning to retirement. 0000015127 00000 n These documents also show your estimated costs for two sample medical events: having a baby and managing diabetes. 0000005030 00000 n Non-contracting dentists will charge employees their regular fee and may bill them for the balance not covered by the dental benefit plan. Please call 1-888-288-2738 and we'll help. Please refer to your Dental Benefit Booklet for additional benefit information. 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. 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 . A type of Health Benefit Plan that allows members to go outside the network for non-emergency care, but may result in a lower level of benefits being paid by the Health Benefit Plan. Outside the United States. For more information on specific coverage you can contact customer service. BlueCare Dental Connectionis a program benefit that provides members with education and intervention through support tools and educational mailings. 0000053119 00000 n Space maintainers Implants coverage available Orthodontic benefits are available on select plans for both children and adults Up to $75 deductible per member, per calendar year Choice of a $1,000, $1,250 or $2,000 calendar-year benefit maximum per member Coverage even when members use a non-network dentist. 0000015051 00000 n