Dental Prime Dental Complete Dental Net. We re helping make it easy to find the best dental coverage for your group.
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1 Dental plans for Cali forn ia group s of 2-50 Dental Prime Dental Complete Dental Net We re helping make it easy to find the best dental coverage for your group. ANTHEM is the registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association Anthem Insurance Companies, Inc. Anthem Blue Cross and Blue Shield is the trade name of, and serves residents and businesses: In Colorado and Nevada: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-hmo benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In New Hampshire: Anthem Health Plans of New anthem.com/specialty Hampshire, Inc. In Ohio: Community Insurance Company In Virginia (excluding the City of Fairfax, the Town of Vienna and the area east of State Route 123), Anthem Health Plans of Virginia, Inc. and its affiliated HMOs, HealthKeepers, Inc., Peninsula Health Care, Inc. and Priority Health Care, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin ( BCBSWi ) which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ( Compcare ) which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS7/11 policies. Independent licensees of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use CAEENABC
2 Our dental plans help fit your unique needs Choosing a dental plan for your employees is all about balance. Cost matters. But so does your employees health. That s why you have options with Anthem dental. We ll help you find the right mix of benefits that can help have the best impact on employees health. And no matter which dental plan you choose, you can count on: Solid coverage at a good price Benefits that work with your health plan Strong network access Service you can rely on Dental plans that work hard for you Our dental plans include: Dental Prime, Dental Complete and Dental Net Dental HMO. With all dental plans, you and your employees will enjoy these standard services. A dental program you can trust Anthem 3 is a leader in the dental benefits business with 40 years of experience. As part of one of the nation s largest health insurance companies, we have the stability needed to compete in today s marketplace. And, we hold an A.M. Best Company Rating of A (Excellent), proof of our strength and stability. Together with our sister companies, we handle more than 70,000 groups and about 8 million people. Easy access to information Your employees have 24/7 online access to their claims and dental plan details. Plus, they ll find materials that help promote dental health. Customer service when you need it Our representatives are informed and ready to answer your questions. And we re committed to providing excellent service. In 2010, our average phone response time was 15 seconds. International Emergency Dental Program Members traveling outside the U.S. have access to a worldwide network of English-speaking dentists for emergency services. 1 Swift claims payments and data-based benefits On average, we pay claims in three days or less, with a financial accuracy of more than 99% in So you can be sure payments are prompt and correct. We also track data from the millions of claims we process each year. For Dental Prime and Complete, we review that data to make sure our dental plan designs align with evidence-based dentistry. That helps you get more value for your money. And access to better dental health benefits for employees and their families. Here s an example of evidence-based dentistry at work. Our Dental Prime and Complete plans cover sealants once every 24 months instead of longer periods of time or once per lifetime. That s because keeping sealants intact helps lower the risk of tooth decay and future repair costs. 1 The International Emergency Dental Program is managed by DeCare Dental. DeCare Dental is an independent company offering dental management services to Anthem Blue Cross. 2 Anthem internal data, Anthem and affiliated companies.
3 Dental Prime and Complete: Plans designed with better health in mind When we created the new Dental Prime and Complete plans, we kept overall health in mind. That s why most dental plans offer: Coverage for dental implants and composite (tooth-colored) fillings on any tooth. Brush biopsy benefits. Brush biopsies with lab analysis, along with surgical biopsies with lab analysis can help detect oral cancer, a sometimes deadly disease. An extra cleaning or periodontal maintenance procedure each year for members who are pregnant or living with diabetes. Optional orthodontic benefits for kids and adults. Diagnostic and preventive services like cleanings and X-rays covered at 100% at a network dentist. These services can be key to long-term dental health. Our networks are broad and easy to use Your employees won t have trouble finding a dentist with our large networks. The Dental Prime contracted network has more than 21,000 access points in California and nearly 86,000 access points nationwide. And the Dental Complete contracted network is our larger network. It has more than 24,000 access points in California and more than 96,000 access points nationwide. When members see a network dentist, they get: Savings: We agree on pricing with network dentists and pass that lower price on to members. Freedom from paperwork: Network dentists file your employees claims with us. No balance billing: If our network dentists charge more than the agreed upon price, they cover the difference not your employees. Members pay only their deductible or coinsurance.
4 Value, Classic and Enhanced dental plans For employer groups of 2-50, we offer a choice of dental plans that fall into our Value, Classic and Enhanced categories. So you can choose the level of benefits that fits your needs and budget. Value dental plans cover the basics like cleanings, exams, X-rays and fillings. Classic dental plans cover basic dental services, as well as most major services, all with high annual maximums. Enhanced dental plans have the greatest coverage, with choices for even higher annual maximums and lower coinsurance. Value Classic Enhanced Passive Active Passive Active Passive Active In-/out-of-network coverage In Out In Out In Out In Out In Out In Out Diagnostic and preventive 100% 100% 100% 80% 100% 100% 100% 80% 100% 100% 100% 100% services (cleanings, exams and X-rays) Basic services (fillings) 80% 80% 80% 60% 80% 80% 80% 60% 90% 90% 90% 80% Major services (crowns, bridges, dentures, etc.) Not covered Not covered 50% 50% 50% 50% 60% 60% 60% 50% Annual deductible (waived for diagnostic and preventive services) Annual benefit maximum (per member) Endodontic, periodontal and oral surgery services Orthodontic coverage (lifetime maximum to match annual maximum) $50 per person ($150 per family) $25 per person ($75 per family) or $50 per person ($150 per family) $25 per person ($75 per family) or $50 per person ($150 per family) $500 or $1,000 $1,000 or $1,500 $2,000 or $2,500 Basic Not covered Basic or Major Basic Not covered 50% children only, 50% adults and children or no coverage 50% children only, 50% adults and children or no coverage Waiting periods (major and ortho) No waiting period No waiting period No waiting period Annual maximum carryover Not available Optional Optional Network Dental Prime contracted or Complete contracted Dental Prime contracted or Complete contracted Dental Prime contracted or Complete contracted Out-of-network reimbursement FAIR Health 80th or 90th percentile or MAC fee schedule FAIR Health 80th or 90th percentile or MAC fee schedule Participation guidelines Groups of 2-4: 100% of eligible employees and 100% of eligible dependents not covered under another dental plan must enroll. Groups of 5 or more: Minimum 60% participation, premium discounts at each 10% increase in participation 60%, 70%, 80%, 90%, 100%. Orthodontia: Minimum of 10 enrolled employees. FAIR Health 80th or 90th percentile or MAC fee schedule
5 Voluntary dental plans We also have voluntary dental plans, which let you offer dental coverage to your employees without adding to your costs. And, only five or more eligible employees have to join to offer these voluntary dental plans. Voluntary Passive Active In-/out-of-network coverage In Out In Out Diagnostic and preventive services (cleanings, exams and X-rays) 100% 100% 100% 80% Basic services (fillings) 80% 80% 80% 60% Major services (crowns, bridges, dentures, etc.) 50% 50% 50% 50% Annual deductible (waived for diagnostic and preventive services) $25 per person ($75 per family) or $50 per person ($150 per family) Annual benefit maximum (per member) $1,000 or $1,500 Endodontic, periodontal and oral surgery services Major Orthodontic coverage (lifetime maximum to match annual maximum) 50% children only or no coverage Waiting periods (major and ortho) 12 months* Annual maximum carryover Optional Network Dental Prime contracted or Complete contracted Out-of-network reimbursement FAIR Health 80th or 90th percentile or MAC fee schedule * Waived if group shows prior comparable coverage with enrollment paperwork. More ways to tailor your dental plan On many Dental Prime and Complete plans, you choose the annual deductible and benefit maximum. Covering orthodontia is up to you. You also get to decide the following: Active or passive benefits Active dental plans provide a higher level of benefits when members use network providers. Passive dental plans have the same level of benefits in and out of network. Out-of-network reimbursement FAIR Health 80th offers a level of repayment based on data from a vendor called FAIR Health. At the 80th percentile, the amount we pay for a service is equal to or greater than 80% of the charges for that service in a given ZIP code. In other words, 80% of dentists in the ZIP code charge that amount or less for the service. FAIR Health 90th works the same as FAIR Health 80th, except at the 90th percentile. The MAC fee schedule offers a cost-effective level of repayment for out-of-network claims. Annual maximum carryover When this feature is included in a Dental Prime or Complete plan, members may carry over unused benefit dollars to the next plan year. To qualify, a few simple rules must be met: Members must be enrolled in the dental plan for the full benefit (calendar) year. They must submit at least one claim for a covered service during that year. The total benefit amount paid for services received under the plan in that same year can t be more than $500. When these guidelines are met, members can apply up to $250 in unused benefits to the next benefit year. This gives them a higher maximum for all covered services. Plus, they may carry over $250 each year until they reach $1,000.
6 Dental Net: An affordable Dental HMO with set member costs Our Dental Net Dental HMO has low or no copays for services provided by members primary care dentists. And unlike many dental plans that limit the amount of services members can receive in a year, Dental Net has no annual maximums. Plus, member costs are predictable because Dental Net has set copays for services like fillings and crowns. Member s copay 1 Diagnostic services Periodic oral examinations X-rays Preventive services Teeth cleaning (prophylaxis): adult or child care Topical fluoride: child Restorative services: filling permanent tooth Fillings: amalgams and 1-3 surface anterior composites Stainless steel crowns: primary teeth $30 Oral surgery services Simple extraction of erupted tooth or exposed root Surgical extraction of erupted tooth $35 Impaction: soft tissue $50 Impaction: partial bony $80 Impaction: full bony $95 Endodontic services Pulp cap: direct or indirect Root canal: anterior $110 Root canal: bicuspid $145 Root canal: molar $240 Therapeutic pulpotomy $10 Member s copay 1 Periodontic services Gingivectomy: one to three teeth per $22 quadrant Gingivectomy: four or more contiguous $85 teeth per quadrant Scaling/root planing: per quadrant $50 Osseous surgery: per quadrant $225 Prosthodontic services Crown: porcelain fused to high $230 2 noble metal Post/core prefabrication $50 Complete denture (including routine $250 3 post-delivery care) Partial denture (including routine $300 post-delivery care) Denture reline: chairside $35 Denture: broken tooth repair $25 Orthodontic services 24 months of standard orthodontic care, exclusive of records/retention fees Child (through age 17) or adult (age 18 and up) Other services Out-of-area emergency care maximum payment: $50 Services rendered at participating orthodontists $1,850 All charges over $50 including applicable copay(s) Office visit: after hours $45 Local anesthesia 1 These copays apply only when services are rendered by a participating dentist. Specialty services provided by a specialty dentist are included on a separate schedule in the member s contract or Evidence of Coverage. 2 Plus actual costs for noble/high (precious) metal not to exceed $ Either type of denture is an acceptable restoration, however, Dental Net benefits the first one placed, not both.
7 Dental Net covers only services that members receive from network dentists. There are more than 6,000 access points in certain California counties. They include: Alameda, Contra Costa, Los Angeles, Marin, Orange, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Luis Obispo, Santa Barbara, Santa Clara, Solano, and Sonoma. Dental Net has limited availability in El Dorado, Kern, Kings, Monterey, Placer, Riverside, San Mateo, Santa Cruz, Tulare and Ventura. Dental Net can be offered on a dual option basis with a Dental Prime or Complete plan. Talk to your Anthem representative about participation guidelines. Discover the Anthem advantage You know us for our health plans. But did you know we re also one of the leading providers of dental, vision and life benefits in the country? These products can be easily packaged with your health plan giving you a comprehensive benefits program that works smarter. Our enhanced dental, vision and life benefits can help improve the overall health of your business and employees. In addition to Dental Prime, Dental Complete and Dental Net, other dental plans may be available in your area. Contact your Anthem representative for more information.
8 Want to learn more? We re ready to help you get the most from your dental plan. For more details about our plans, visit anthem.com/specialty. Or contact your broker or Anthem representative for a quote. Life products underwritten by Anthem Blue Cross Life and Health Insurance Company. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.
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