DentalBlue for
IndividualsSM Benefits &
Rates (see below)
For Individuals And Families
With DentalBlue for IndividualsSM, you'll have access to preventive
services such as checkups and cleanings that will help
protect your teeth and maintain good oral health.
DentalBlue for IndividualsSM also covers a broad range of basic and major
services, from fillings, root canals and surgery to gum
treatment, crowns and bridges. And best of all, you can
see any dentist you like. There are no restrictions or
in-network requirements. DentalBlue for IndividualsSM makes it easy.
Nearly 75 percent of American adults have some form of
periodontal disease and the symptoms of gum disease can
be so mild that some people don't know they have it.
Each year, in excess of 5.1 million hours of school
among children are lost due to dental illness or dental
visits.3 Recent reports also indicate a relationship
between gum disease and stroke, heart disease, diabetes,
pre-term or low-birth-weight babies and more. Along
with proper daily dental care, regular dental checkups
can help detect, prevent and treat gum disease and the
disorders that go along with it. By selecting DentalBlue for IndividualsSM,
you'll be taking a significant step toward protecting
your overall health.
|
Type of coverage |
Plan benefits |
|
Preventive services Routine oral exams, Adult and child cleaning, Bitewing X-rays, Sealants (members 5 to 15 years old only), Pulp testing, Fluoride cleaning (members through 18 years old only), Palliative emergency treatment, Emergency oral examinations, Other diagnostic and preventive services |
100% |
|
Basic services Fillings, Space maintainers (members under 16 years old only), Endodontics, Simple extractions, Oral surgery, Other basic services |
60% |
|
Major services Gingiva l curettage, Gingivectomy and gingivoplasty, Periodontal maintenance, Inlays and onlays (once per 5 years), Crowns and bridges, Dentures, Other major services |
50% |
|
Annual maximum, all services (per covered member) |
$1,000 |
|
Waiting periods Diagnostic and preventive services / Basic services / Major services |
None / 6 months / 12 months |
|
Deductible Basic and major services |
$75 |
You and your dependents are eligible for DentalBlue for IndividualsSM if you are residents of North Carolina. If your application is received on or before the 20th of the month, your coverage will be effective on the first day of the next month. If your application is received after the 20th, coverage will take effect on the first day of the following month. For example, coverage for an application received from May 1 to May 20, will begin June 1. Coverage for an application received from May 21 to May 31 will begin July 1.
This is a partial list of services that are not covered by DentalBlue for IndividualsSM for Individuals. Your coverage may be canceled by Blue Cross and Blue Shield of North Carolina® for failure to pay premiums when due and for fraudulent statements on your application, among other reasons.
Members will be notified 30 days in advance of any change in coverage. Consult your member guide for complete information. Your dental benefits plan does not cover services, supplies, drugs or charges that are:
- Orthodontic services
- Not clinically necessary
- Investigational in nature or obsolete, including any service, drugs, procedure or treatment directly related to an investigational treatment
- Not prescribed or performed by or upon the direction of a dentist or other provider
- Received prior to the member's effective date
- Received on or after the coverage termination date, regardless of when the treated condition occurred or whether the care is a continuation of care received prior to the termination
- For telephone consultations, failure to keep a scheduled visit, completion of a claim form, obtaining dental records, and late payments.
- Incurred more than 18 months prior to submission of a claim to BCBSNC®
- For complications or side effects arising from services, procedures, or treatments excluded coverage under the dental benefits plan
- Provided and billed by a licensed dental care professional who is in training.
- Available to a member without charge
- For care given to a member by a provider who is in the member's immediate family
- In excess of the allowed amount.
- Cosmetic services
- For dental implants, oral orthodontic devices and palatal expanders, except as specifically covered by your dental benefits plan.
- Dental services provided in a hospital, except when a hazardous condition exists at the same time, or if covered oral surgery services are required at the same time as a result of a bodily injury.