This program provides members with education and intervention through support tools and educational mailings. Learn more about eligibility and resources for uniformed service members transitioning to retirement. BlueCare Dental HMOSM Voluntary Plan is a PPO that requires no employer contribution while still offering the employees the benefit of dental coverage in one of the largest dental PPO networks. Our BlueCare DentalSM program offers two network-based dental products. To learn more about dental benefits for STAR children, see the STAR Member Handbook. Your child's Medicaid dental plan provides dental services including services that help prevent tooth decay and services that fix dental problems. Bitewing X-rays 0000115129 00000 n H\n0E Oral surgery Need help understanding and choosing a benefit plan? Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. 0000041318 00000 n Learn more about dental services for adult STAR members. Any additional costs are paid by the member out of pocket. The group must also offer an alternate dental option to HMO. 0000009079 00000 n Get access to your agent portal.Register Now. We provide health insurance in Michigan. Bridges and dentures endstream endobj 66 0 obj <> endobj 67 0 obj <>stream Download or print your benefit information. 0000014575 00000 n 0000047395 00000 n The fee determined by an MCO (managed care organization) to be acceptable for a procedure or service, which the physician agrees to accept as payment in full. These documents also show your estimated costs for two sample medical events: having a baby and managing diabetes. Understanding yourBlue Cross Blue ShieldFEP Dental coverage is the key to making the most of your 0000041910 00000 n Use ourProvider Finderto search for doctors and pharmacies near you. These budget-friendly insurance options help lessen the financial impact of unexpected health care costs. 0000009905 00000 n The designation is based on evidence-based, objective selection criteria established with input from expert physicians and recommendations from medical organizations . For travellers, the app is the fastest way to buy and manage Canada's most trusted brand in travel insurance. 0000070270 00000 n Call: 833-901-1364 Learn more. An extension of the Blue Cross Blue Shield WalkingWorks program, this event helps people incorporate physical activity into their workday and encourages them to increase their daily physical activity by walking at lunch. A contract provision, included in all standard provider contracts, that allows either the MCO (managed care organization) or the provider to terminate the contract when the other party does not live up to its contractual obligations. Limitations and Exclusions Exclusions Carries an ID card with this identifier on it. 0000002644 00000 n Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2022- 12/31/2022 Anthem Blue Cross: PORAC Prudent Buyer PPO Plan Coverage for: Individual + Family | Plan Type: PPO CA/L/A/CalPERS PPOC20800:PORACPrudentBuy-PPO/NA/UQBHJ/NA/01-22 1 %%EOF PDF File is in portable document format (PDF). 0000009480 00000 n The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. It also gives you the freedom to choose any dentist you want by helping to cover the cost of care when you see a dentist who isn't in our PPO network. 00421 These documents also show your estimated costs for two sample medical events: having a baby and managing diabetes. 0000000016 00000 n Use our Premium Finder to easily find your premium amount or take a look at the tables below to determine your premiums. With BlueCare Dental PPO 1A, you'll get: One of the highest maximum annual benefit levels available - up to $1,500 per person per year Orthodontic services covered up to age 19 No annual maximum on BlueCare Dental 4 Kids 1A Get access to your provider portal.Register Now, Not registered? A coding inconsistency that involves separating a procedure into parts and charging for each part rather than using a single code for the entire procedure. Register Now. Addresses the health and lifestyle needs of consumers through unique partnerships and experiences designed exclusively for Blue365 members. During this unprecedented time, we're taking action to support our members. This new site may be offered by a vendor or an independent third party. If you are calling from April 1 through September 30, If a member . 0000080580 00000 n This new site may be offered by a vendor or an independent third party. 0000059102 00000 n 0000062841 00000 n Outside the United States. For more detailed information on the plan designs available, covered benefits, services and supplies that are limited or excluded, general administration of the plan, or any other questions you may have regarding our products and services, please contact your account representative for the phone number of the regional sales office near you. c< 44 79 Children can get pediatric benefits until the end of the calendar year in which they turn 19. 0000005030 00000 n T9"TaS~mMeOL2Xi$HS#f8eN@PW :V 5nw_qTKRPHKj:rfYqb7u/l&9T5oku`!r[Wsv^t';/#3B^>`BlHj\vu$8JaaJt\#+h1%Dj-M*9=>G@i[f>H!3nC1*kjytKuT8dF z|/ yA'#G*'zY6#a)8FXwTs;K:q*i97O|yr,f9+:BMg/tY6x43rXN^r>9sDGLt7A3RCsJ%s m7 0000063121 00000 n These services are covered 12 months after you first join a Blue Dental plan. Traditional insurance offers the most freedom of choice and control over healthcare, but benefits are maximized when using a participating Blue Cross Blue Shield company. Questions? BCBSOK and go2dental.com are separate companies. Covered once per tooth every 60 months. 0000107561 00000 n The MCO (managed care organization) committee that evaluates proposed policies and action plans related to clinical practice management, including changes in provider contracts, compensation and changes in authorization procedures. One option is Adobe Reader which has a built-in reader. A document that provides background information about various underwriting impairments and suggests the appropriate action to take if such impairments exist. 0000074942 00000 n Your employer should be able to provide a benefit booklet for you which will provide some details of your coverage. Register Now, Not registered? BlueCare Dental PPOSM has one of the largest dental PPO networks of general and specialty dentists in both Illinois and nationally, which offers members flexibility in choosing a provider. 0000047131 00000 n The deductible is usually a set amount or percentage determined by the members contract and is set for a given period of time. State and Federal Privacy laws prohibit unauthorized access to Member's private information. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. Plus, it can help them manage their out-of-pocket costs. Limited to three times a year in combination with routine cleaning. Important Legal and Privacy Information |Important Information About MedicarePlans| Privacy Practices | Site Map | Feedback | Download Adobe Acrobat Reader, All-Ages Dental Certificate of Coverage (PDF), Important Information About MedicarePlans. 0000107898 00000 n Check out our Member Education Materials to get more information aboutBlue Cross Members choose in-network care or out-of-network care at the time they make their dental appointment and usually incur higher out-of-pocket costs for out-of-network care. We provide health insurance in Michigan. endstream endobj 68 0 obj <> endobj 69 0 obj <> endobj 70 0 obj <> endobj 71 0 obj <> endobj 72 0 obj <> endobj 73 0 obj <>stream 4VOCevR%M"|~GHI84SRhX/ The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. Complete dentures covered once per arch every 84 months; partial dentures and bridges covered once per arch every 84 months for members age 16 and older. Standard Option members already receive this benefit. It's usually figured as a percentage of the amount we allow to be charged for services. Learn more about dental services for adult STAR members, 8 a.m. to 5 p.m. Central Time Monday through Friday. The BlueCare Dental PPO product is a product available for purchase on a self-funded basis only. Check out our FAQs page to get answers to questions, or Contact Us with any questions you may have. The services covered include: Teeth cleanings. The provision of mental health and chemical dependency (or substance abuse) services. endstream endobj 45 0 obj <> endobj 46 0 obj <> endobj 47 0 obj <> endobj 48 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageB]/XObject<>>> endobj 49 0 obj <> endobj 50 0 obj <> endobj 51 0 obj <> endobj 52 0 obj <> endobj 53 0 obj <> endobj 54 0 obj <> endobj 55 0 obj <> endobj 56 0 obj <> endobj 57 0 obj <> endobj 58 0 obj <> endobj 59 0 obj <> endobj 60 0 obj <> endobj 61 0 obj <> endobj 62 0 obj <> endobj 63 0 obj <> endobj 64 0 obj <> endobj 65 0 obj <>stream Also known as drug cards or prescription cards. 0000076479 00000 n Search for Doctors, Hospitals and Dentists Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. Maximum dollar amounts set by MCOs (managed care organizations) that limit the total amount the plan must pay for all healthcare services provided to a subscriber per year or in his/her lifetime. To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. A benefit payment system in which an insurer reimburses the group member or pays the provider directly for each covered medical expense after the expense has been incurred. A set of specialized healthcare services that provide support to terminally ill patients and their families. In Texas, Medicaid is the program that will offer the most comprehensive dental coverage, especially for children (anyone under 21). 0000011650 00000 n Blue Cross Blue Shield of Minnesota A healthcare system that assumes or shares both the financial risks and the delivery risks associated with providing comprehensive medical services to a voluntarily enrolled population in a particular geographic area, usually in return for a fixed, prepaid fee. Root canals Medical advisory committees also review data regarding new medical technology and examine proposed medical policies. ]YAVdYAV/E Ue-f}zM^+r5{dV9KfK.K.K.#Q6zzz=^W+kta8e6E6e6Eldtdx$LNp9- endstream endobj 27 0 obj <> endobj 28 0 obj <>stream Once youve reached this out-of-pocket maximum, your plan pays 100 percent of the allowed amount. Posted: Apr 25, 2023 / 03:27 PM CDT. Individuals attempting unauthorized access will be prosecuted. Select "Log In To My Account" from the large center banner A process through which an organization validates credentialing information from the organization that originally conferred or issued the credentialing element to the practitioner. 0000088585 00000 n June 17, 2022 . 0000002793 00000 n 0000049163 00000 n Dependent coverage Unmarried dependent children are covered under age 26 or under age 30 if a military veteran. Groups with 151+ Employees The member's location at the time of service is irrelevant. Cleanings are covered twice a year. Preventive care programs designed to determine if a health condition is present even if a member has not experienced symptoms of the problem. The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. 0000139675 00000 n We will work with and follow all COVID-19 guidance and protocols provided by the Centers for Disease Control A computerized record of a patient's clinical, demographic and administrative data. 0000049889 00000 n Includes coordination of benefits, Workers' Compensation, subrogation and no-fault auto insurance. Blue Distinction Centers for Specialty Care, Need to Make a Payment? PII, as used in these Inter-Plan Programs Policies and Provisions, may have other meanings as assigned by various state laws related to data security breach notification. 'on[/b,k"=|g/my6Johp!?yuv9R`LZM8eW$@'I#Z%%@CX2`A6*a)TtAMb?|,*+9 ?B%UFV)l)ypvwIH rtB!gvdPW;R13LmVDwfeLki]CxEb5n>OT|~_Yz[pw\;Oh1O70A|S|S? Patients and members can also call Yavapai Regional Medical Center at 702-616-5789 for assistance or questions. Learn more about BCBS FEP Dental plan benefits and premiums. . Call Dentaquest at 1-800-516-0165,MCNA Dental at 1-800-494-6262or UnitedHealthcare Dental at 1-800-822-5353. This out-of-pocket maximum is the most youll have to pay during a calendar year for covered pediatric dental services. 0000050197 00000 n 0000006903 00000 n There is no need to submit a paper claim. Visit www.bcbsmt.com/member 2. Covered once per tooth per lifetime. 0000005663 00000 n Covered once per arch every 84 months. Class IV services are not covered. r9J2InHV`@Lb`\a%diF`3200h f`ig`` a BlueCare Dental Choice PPO - This is known as an active plan design. Your deductible is the amount you pay for dental services each year before your insurance begins to pay. %PDF-1.4 % Does Blue Cross and blue shield of Texas (bcbstx) have a dental Wellness Center? 0000055326 00000 n Need help understanding and choosing a benefit plan? Is your health coverage changing. Covered once per tooth per lifetime. 0000006097 00000 n : ]O,l22/JX.bx.`=+cJ|?% As a member of Blue Cross Blue Shield FEP Dental, we aim to provide the highest level of service available. Unfortunately, Medicaid does not cover cosmetic dentistry procedures like veneers. An important component of BlueCare Dental Connection is the Dental Wellness CenterTM*, which will be available to members and offers online resources and support tools that allow members to: Note: The information provided by the BlueCare Dental Connection program is not a substitute for professional health care. In group health insurance, generally a condition for which an individual received medical care during the three months immediately prior to the effective date of coverage. 1-800-267-8221. A free-standing center that performs various types of surgery. HUKo@WoR",8iiz5f. See also precertification. 1996-document.write(new Date().getFullYear()); Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. PDENT is your dental plan. Individuals attempting unauthorized access will be prosecuted. When you partner with Blue Cross Blue Shield of Michigan, you're selecting the strongest network of providers in Michigan. Access Your Payment Options. The Patient Protection and Affordable Care Act (commonly called the ACA) was signed into law in 2010 to address access, quality and cost in the healthcare industry. Coverage for treatments varies depending on the member's benefit plan. The plan features comprehensive and flexible options for coverage across three levelsGold, Silver, and Bronzeas well as some exciting new benefits that promote health equity in our province. Contact Pacific Blue Cross for more information or to speak with one of our Service Representatives: Individual Plans Sales and Support Telephone: 604 419 2000 Fax: 604 419 2199 Email: inhealth@pac.bluecross.ca Toll-free Outside the Greater Vancouver Area: The website lets members log daily activities and track progress over time. Blue ShieldFEP Dental's value and offerings. 0000006502 00000 n 0000006015 00000 n To view this file, you may need to install a PDF reader program. To give you an accurate price, we'll need some information. 2021 SUMMARY OF BENEFITS 0000107816 00000 n Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Provides greater healthcare transparency by delivering detail about healthcare trends and best practices, resulting in healthier lives and affordable access to safe and effective care. IV. 2900 Ames Crossing Road ; Eagan, MN 55121 1-800-693-6703 . Scroll. Plan Type: PDENT BlueCare Dental Connection Take Advantage of Dental and Discount Programs As a valued member, you have access to a variety of tools and resources to help you and your loved ones manage your oral health and save money through our discount programs. For dental care, you can go to any licensed dentist and this plan will share the cost. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association NOT FOR DISTRIBUTION TO BENEFICIARIES, MEMBERS, OR PROSPECTS BlueCare Dental Classic Plans 1,2 BlueCare Dental Classic plans cover only one person per policy. 0000006747 00000 n Blue Cross and Blue Shield of Oklahoma (BCBSOK) is providing access to the Dental Wellness Center website as a courtesy, as part of its BlueCare Dental Connection program. If you're considering enrolling in one of our individual and family plans, learn a bit more about the coverage you'll receive. Find a planto get a quote. Have us call you by filling outthis online form. Pursuant to Section 1557 Blue Cross Blue Shield FEP Dental does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, age, disability, or sex (including pregnancy and gender identity). You are about to leave Blue Cross and Blue Shield of Alabama's website and enter a website operated by HealthEquity. For all of your dental questions and/or claim forms, please contact your local Blue Cross Blue Shield company. This is the limit on what your plan pays for dental care benefits for members who are 19 or older when their plan starts. President of Blue Cross and Blue Shield of Texas The Dental Schedule of Coverage enclosed with this Benefit Booklet indicates benefit percentages, Deductibles, maximums, and other benefit and payment issues that apply to the Plan. A contract provision that allows either the MCO (managed care organization) or the provider to terminate the contract without providing a reason or offering an appeals process. 1. An evaluation of the medical necessity, appropriateness and cost-effectiveness of healthcare services and treatment plans for a given patient. The direct care provider should file claims to the local Blue Cross Blue Shield company. Most PDF readers are a free download. (Coverage is not available for non-network dentists in Massachusetts except for covered emergency services.) For all of your dental questions and/or claim forms, please contact your local Blue Cross Blue Shield company. Accounts that employers can establish for employees to reimburse a portion of their eligible family members' out-of-pocket medical expenses, such as deductibles, coinsurance and pharmacy expenses. Use our Find a Provider tool to 0000005327 00000 n Please refer to your Dental Benefit Booklet for additional benefit information. The program integrates dental care management and health care management with a focus on preventive care and individual involvement. 0000069257 00000 n The provider of service is the one who files a claim for a service supplied to the member. 0000023853 00000 n Healthcare services provided to a health maintenance organization (HMO) member in exchange for a fixed, monthly premium paid in advance of the delivery of medical care. The Medicare component that provides benefits to cover the costs of physicians' professional services, whether the services are provided in a hospital, a physician's office, an extended-care facility, a nursing home or an insured's home. DentaQuest can help members find in-network providers and get authorizations for dental services. 100% coverage for periodontal cleanings to members with specific health issues at no additional cost. Dental exams 0000005867 00000 n Non-contracting dentists will charge employees their regular fee and may bill them for the balance not covered by the dental benefit plan. Free language assistance to people whose primary language is not English, such as: Calling Blue Cross Blue Shield FEP Dental at 1-855-504-BLUE (2583), dial 711 for TTY relay services. General medical care that is provided directly to a patient without referral from another physician. PII does not include publicly available information that is lawfully made available to the general public from federal, state or local government records or widely distributed media. BlueCard Enables members to receive healthcare services wherever they live or travel, nationally or internationally. If the member elects to receive care from BlueCare Dental network providers: If the member elects to receive care from providers outside of the network, they may choose: In addition, members have access to the BlueCare Dental ConnectionSMprogram. Not Registered? Also known as a group practice model HMO. BlueCard Access assists members who need a referral to a physician or healthcare facility in another location. We want you to be informed so that you can get the most appropriate and cost-effective care. Log in and look. 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