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Essential Certified

Blue Dental Essential Certified offers comprehensive benefits at a lower premium cost with slightly higher out-of-pocket cost for covered services.

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Essential Certified

PLAN

=

Advantage Plus

NETWORK

Two out of three dollar signs for cost and three umbrellas out of three for coverage
Here are some plan features and benefits:
  • Coverage for major services such as dental surgery, root canals and crowns
  • Annual benefit maximum of $1,000
  • $75 annual deductible per adult; $50 annual deductible per child
  • No out-of-pocket costs and no deductible for preventive dental care – exams and cleanings
  • Coverage for simple extractions and fillings
  • Pediatric dental coverage and coverage for medically necessary orthodontia for children up to age 21
  • Coverage for adults age 21 and over
  • Coverage for in- and out-of-network services

Essential Certified
Benefits
Deductible (per adult member each year)1 $75
Deductible (per member under 21 per calendar year)1 $50
Adult benefit maximum per year - members age 21 and older $1,000
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 Contract Pays Adult Waiting Period
Routine Oral Exams and Cleanings1 100% 100% None
Oral X-Rays1 100% 50% None
Fluoride Treatments1, Sealants1 100% Not Covered Not Covered
Palliative Treatment (Emergency)1 100% 80% None
Basic Restorative (Amalgam, Resin Fillings), Endodontics 80% 50% 6 months
Oral Surgery, Surgical Extractions 80% 50% 12 months
Simple Extractions 80% 50% None
Periodontics - Surgical and Non-Surgical 80% 50% 12 months
Crown Repairs 80% 50% 12 months
Crowns and Prosthetics (Bridges, Dentures) 50% 50% 12 months
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
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.

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