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Dental
The Dental Plans cover preventive, basic, and major services,
as well as orthodontia. Two options are available:
• Anthem Blue Cross PPO Dental Plan
• Anthem Blue Cross HMO Dental Plan (for California
residents only)
Anthem Blue Cross PPO Dental Plan
With the Anthem Blue Cross PPO Dental Plan you can visit
any dentist and receive benefits; however, you will receive
the greatest value for your dollar when you use network
dentists. All dentists nationwide participating in the Anthem
Blue Cross Dental Blue Complete Network 100, 200 or 300
are considered Network dentists* under the LAPRA PPO
Dental Plan. Network dentists have contracted with the plan
to provide services at reduced rates, so using these dentists
will save you money. Plus, deductibles do not apply when
you use in-network dentists.
If you choose a non-network dentist, the plan will still
provide benefits, but your out-of-pocket expenses may be
higher, because the Anthem Blue Cross negotiated fees do
not apply to non-network dentists. There is no deductible
for non-network preventive and diagnostic services.
IMPORTANT: When using a non-network provider under
the Anthem Blue Cross PPO Dental Plan, the maximum
allowable charge is based on the customary and reasonable
charge for professional services as determined by Anthem
Blue Cross. Members are responsible for any difference
between the non-network provider’s actual charge and the
maximum allowable charge, as well as any deductible and/
or coinsurance percentage.
Anthem Blue Cross HMO Dental Plan
The HMO Dental Plan offers comprehensive coverage
designed to fit your family’s budget. All services must be
performed by an Anthem Blue Cross HMO Dental provider
in order to be covered. Many services are covered at 100%,
while others require a co-pay. Deductibles and calendar
year maximums do not apply. Each family member may
choose a different primary dentist and should be listed
on your enrollment form. If you do not list a primary
dentist on your enrollment form, Anthem Blue Cross will
automatically assign one to you within 30 miles from your
home address. If you’re not satisfied with Anthem Blue
Cross’ selection, you should call Anthem Blue Cross at
866-527-5801 to request a change in primary dentist.
This plan is only available to California residents.
*
All claims incurred in Idaho or Montana will be paid as in-network.
Something to
Smile About
The Anthem Blue Cross PPO Dental
Plan is designed for individuals
and families to promote good oral
hygiene and offer convenient,
affordable dental coverage.
Highlights of the plan include:
• Access to a broad nationwide
network of preferred dentists with
in-network coverage available
in most geographic locations
regardless of state residency
• No deductible with network
providers
• No deductible for Preventive and
Diagnostic services (network and
non-network)
• Calendar year maximum of $2,000
per person
• Lifetime maximum of $1,750 for
orthodontia
• Three cleanings per calendar year
covered at 100% (one additional
cleaning per calendar year for
pregnant women)
• Freedom to choose any dentist
To find an Anthem Blue Cross dental
provider in your area, follow the
instructions on page 9.