PREFERRED DENTAL NETWORK

Blue Cross Blue Shield of Alabama’s Dental Network is a statewide dental network. This managed care program is designed to promote quality and cost effective dental care.  Currently more than 1,260 dentists, approximately 74% of the dentists in Alabama, have joined this program.

The Dental Network Offers the Following Advantages:

Network Dentists will file all claims and accept the Blue Cross payment as payment in full (after any deductible and coinsurance you owe).

Preferred Dentists have agreed to accept our fee schedule as payment in full for covered services (after deductible and coinsurance).  The fee schedule offers average savings of approximately 20% off billed charges.

The categories of dental services covered, level of coverage for each category, and the deductible and maximum amounts will be the same for network and non-network dentists.

Payment for services provided by dentists outside the network in Alabama will also be made according to the Network Dentist fee schedule amount.

If you do not use a Network Dentist, Blue Cross will pay you the Network Dentist fee schedule amount for covered services received.  You may be responsible for the difference between the Blue Cross payment and the dentist’s charge (plus any deductible and coinsurance).  You may also have to file the claim if your dentist’s office will not.

The Managed Dental Network – another reason why Blue Cross and Blue Shield of Alabama is the leader in managed care.

BENEFITS

COVERAGE

Deductible

$50 deductible per person each calendar year; maximum of 3 deductibles per family each calendar year.

Maximum

$1,000 per person each calendar year

Basic Diagnostic and Preventive Services

Payable at 100% (no deductible).

1.  Dental exams up to twice per calendar period.

2.  Dental X-ray exams:

Full month X-rays, one set during any 36 months in a row;

Bitewing X-rays, up to twice per calendat year; and

Other dental X-rays, used to diagnose a specific condition.

3.  Tooth sealants on teeth numbers 3, 14, 19 and 30, limited to one application per tooth each 48 months.  Benefits are limited to a maximum payment of $20 per tooth and limited to the first permanent molars of children through age 13.

4.  Fluoride treatment for children through age 18, twice per calendar year.

5.  Routine cleanings, twice per benefit period.

6.  Space maintainers (not made of precious metals) that replace prematurely lost teeth for children through age 18.

Restorative Services

Payable at 100%

1.  Fillings made of silver amalgam and synthetic tooth color materials.

2.  Simple tooth extractions.

3.  Direct pulp capping, removal of pulp and root canal treatment.

4.  Repairs to removable dentures.

5.  Emergency treatment for pain.

Supplemental

Payable at 100%.

1.  Oral surgery to treat fractures and dislocations of the jaw, to diagnose and treat mouth cysts and abscesses,  and for tooth extractions and impacted teeth.

2.  General anesthesia given for oral or dental surgery.  This means drugs injected or inhaled for relaxation or to lessen pain,  or to make unconscious,  but not analgesics, drugs given by local infiltration, or nitrous oxide.

3.  Treatment of the root tip of the tooth including its removal.

Periodontal Services

Payable at 80%.

1.  Periodontic exams each 12 months.

2.  Removal of diseased gum tissue and reconstructing gums.

3.  Removal of diseased bone.

4.  Reconstruction of gums and mucous membranes by surgery.

5.  Removing plaque and calculus below the gum line for periodontal disease.

Prosthetic Services

Payable at 50%.

1.  Full or partial dentures.

2.  Fixed or removable bridges.

3.  Inlays, onlays, veneers, or crowns to restore the upper or lower dental arch satisfactorily, we will pay as though it were supplied even if you chose a more expensive means.

Limits on prosthetic services;

1.  Partial Dentures - If a removable partial denture can restore the upper or lower dental arch satisfactorily, we will pay as though it were supplied even if you chose a more expensive means.

2.  Precision Attachments - There are no benefits for precision attachments.

3.  Dentures - We pay only toward standard dentures.

4.  Replacement of Existing Dentures, Fixed Bridgework, Veneers, or Crowns - We pay toward replacing an existing denture, fixed bridgework, veneer, or crown only if the old one can't be fixed.  If one can be fixed, we will pay toward fixing it ( this includes repairs to fixed dentures).   Only pay to replace these items every five years.

5.  There are no benefits to replace lost or stolen items.

Application changes or additions requested after the initial 30 days of employment will not be approved by Blue Cross/Blue Shield.

This is not a contract.  Benefits are subject to the terms, limitations and conditions of the group contract.