Preferred Certified |
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Benefits | |||
Deductible (per adult member each year)1 | $50 | ||
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 |
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Child2 No Waiting Period | Adult | Adult Waiting Period | |
Routine Oral Exams and Cleanings1 | 100% | 100% | None |
Oral X-Rays1 | 100% | 100% | None |
Fluoride Treatments1, Sealants1 | 100% | Not Covered | Not Covered |
Palliative Treatment (Emergency)1 | 100% | 80% | None |
Basic Restorative (Amalgam, Resin Fillings), Endodontics | 80% | 80% | 6 months |
Oral Surgery, Surgical Extractions | 80% | 80% | 12 months |
Simple Extractions | 80% | 80% | None |
Periodontics - Surgical and Non-Surgical | 80% | 80% | 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 | |||
2Members under age 21. Certain benefits are limited to children younger than 18. | |||
See contract and schedule of benefits for coverage exclusions and limitations | |||
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. |
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*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. |