Coverage You Can Smile About. Your DentalBlue

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1 Coverage You Can Smile About Your DentalBlue

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3 Your DentalBlue plan from BlueCross BlueShield of Tennessee gives you dental coverage, convenience, and exceptional customer service all from one of the most trusted names in the business. Good dental care is important to your overall health. Nearly all serious dental problems begin with gradual deterioration of the teeth and gums. That s why preventive dentistry is a key factor in helping you avoid major dental problems and major dental bills. With DentalBlue from BlueCross BlueShield of Tennessee, preventive care benefits mean you have an incentive to visit your dentist regularly. Having routine dental exams every six months is the best way to assure that small dental problems won t become large, expensive ones. 1

4 Check Your Plan Options And Benefits BlueCross BlueShield of Tennessee has many standard plan designs. Check your Schedule of Benefits to see the specific plan option, plan limits, deductible and member coinsurance levels that apply to you. Benefits are arranged in four levels of coverage, A-D, as summarized on the next page. Not all dental services are covered by this plan and some services can be covered in level B or C. Check the exclusions and limitations in your Schedule of Benefits to see what is not covered. 2

5 Note: The exact services available to you may vary based on your specific plan or contract. Some plans do not include coverage for all four levels, may be moved to level C or may have waiting periods. Check your Schedule of Benefits to verify your coverage levels and plan specifics. Coverage A Diagnostic Services exams, X-rays Preventive Services prophylaxis (cleanings), fluoride, sealants, and space maintainers Coverage B Basic Restorative Services amalgams restorations (silver filings), resin composite restorations (tooth colored filings), and stainless steel crowns Basic and Major Endodontics 1 pulpotomy, pulpal therapy, and root canal treatment Basic and Major Periodontics 1 non surgical periodontics, including periodontal scaling and root planning, debridement and periodontal maintenance procedures; surgical periodontics, including gingivectomy, osseous surgery, and grafting Basic and Major Oral Surgery 1 non-surgical or simple extractions, surgical extractions and other surgical procedures typically not covered under a medical plan Other Services palliative (emergency) treatment for relief of pain, denture repairs Coverage C 2 Major Restorative crowns, inlays, onlays, veneers, and other restorative services Prosthodontic Services fixed partial dentures (bridges), removable dentures, and other prosthodontic services Coverage D 2 Orthodontic Services for the straightening and alignment of teeth, including exams, photographic images, diagnostic casts, X-rays, installation, and adjustment of orthodontic appliances. 1 Services may be moved to coverage level C on some plans. 2 Services not available in some plans. 3

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7 Your DentalBlue Network With more than 2,400 dentist locations in Tennessee and its bordering counties, your DentalBlue plan has the largest dental PPO network (Preferred Provider Organization network) in Tennessee. And DentalBlue offers even more. When you are outside of the Tennessee service area, you can still choose to see a network dentist through our national network solution. More than 90,000 dentists in all 50 states participate, giving you the option to use a network dentist anywhere. To locate an out-ofstate provider, simply go to bcbst.com and click on Find a Doctor. Then click on Dentist and select the outside of Tennessee network option. You can search by city, state, county, or zip code so it s easy to find a dentist near you. DentalBlue Network Basics Using dentists that participate in your DentalBlue plan is important, because DentalBlue network dentists have agreed to discount their services for you. So, to save money and make the most of your dental plan benefits, make sure you choose participating dentists and understand how your benefits will be paid. You can check the directory online anytime at bcbst.com for the most up-todate listings. Participating Dentists. Participating dentists agree to accept the dental network allowance as full payment for services they provide. Participating dentists can only collect deductibles, coinsurance, and payment for non-covered services or supplies from you. Your deductible and coinsurance amount for covered dental services is listed on your Schedule of Benefits. 5

8 Predetermination of Benefits. Except for emergency care, you and your dentist can determine exactly what is covered by your dental plan and the amount the plan will pay before your treatment begins. After your exam, your dentist can complete and submit a Dentist s Statement to BlueCross BlueShield of Tennessee. Then you both will be notified of the exact benefits the plan will provide for your treatment. A predetermination is recommended for any service that may exceed a $200 charge. 6

9 Payment For Services By A Non-Participating Dentist. Under DentalBlue, you are free to go to the dentist of your choice. But if you visit a nonparticipating dentist, the benefit payment will be based on a maximum allowable fee schedule and may be made directly to you. A non-participating dentist may charge more than the amount of the maximum allowable fee schedule. And this difference often called balance billing would be your responsibility to pay. Why Are Dental Networks So Important? Networks Protect You From Balance Billing. Dentist fees rise steadily each year, and there is a wide range of fees they charge. Your dental plan helps keep those costs in line by setting an upper limit on an appropriate fee, often called the maximum allowable charge. Network dentists agree to this standard, discounted fee. Even if it is less than what they charge some of their other patients, they cannot charge you the higher amount or balance bill you the difference. Did you know? If you use a nonnetwork dentist that balance bills, you could pay up to 30% more for your dental care. Networks Stretch Your Benefit Dollar. Even though some restorative and specialty services cost $1,000 or more, most dental plans still have an annual maximum benefit of $1,000. When network dentists discount their fees, you save money. This translates into less benefit used and more benefit left over. Did you know? You already pay 30% or more of dental costs through coinsurance, deductibles, and plan limits? 7

10 Enjoy Added Value with BlueAccess and BluePerks With your DentalBlue plan, you re always just a phone call away from BlueCross BlueShield of Tennessee and highly trained member service representatives who know and understand every aspect of your benefit plan. Plus, you can visit the Web site at bcbst.com and use BlueAccess any time you need to check your dental benefits or look up your claims information. Along with your DentalBlue plan benefits, you also get the value-added benefits of discounts with BluePerks. BluePerks features discounts of up to 50% on non-covered products and services such as routine vision and LASIK corrective vision surgery, weight loss programs, prescription drugs, vitamins, health club memberships, personal trainers, massage therapy, spa services, acupuncture and more. Just check the BluePerks information online at bcbst.com to find a participating BluePerks provider near you. These and other valuable benefits and services from BlueCross BlueShield of Tennessee make it easier for you to manage your dental benefits and enhance your personal health program. 8

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12 One Cameron Hill Circle Chattanooga, TN bcbst.com BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association This document has been classified as public information COMM-DEN-01 (5/09)