BlueCare Dental HMO Enrollment Guide Blue Cross and Blue Shield of Illinois
1 Learn about us 2 Benefits, an overview 4 Questions frequently asked
Learn ABOUT US The Leader in Health Care Benefits Blue Cross and Blue Shield of Illinois Coverage for dental care and treatment is an important part of your benefit package. That s why your employer is offering you an affordable dental plan that is backed by Blue Cross and Blue Shield of Illinois, an industry leader. With more than 65 years of experience, Blue Cross provides health care benefits to more people than any other plan in the state. Blue Cross has earned a reputation for service and dependability by focusing on members. Now you can rely on Blue Cross for a dental plan that meets your needs and the needs of your covered family members. The Dental HMO Advantage The BlueCare Dental HMO plan emphasizes prevention while also offering benefits for an array of primary and major dental services. BlueCare Dental HMO gives you the convenience of receiving affordable dental care from one of the largest dental HMO networks in Illinois. Like a medical HMO, you must select a participating primary care dentist to provide and coordinate dental care and treatment for you and your eligible dependents. When you receive care from a participating dentist, there are no deductibles or surprise expenses and no cumbersome claim forms to fill out. It s important that you become a partner with your primary care dentist and that you ask your dentist questions about your oral health and dental treatment. With BlueCare Dental HMO, preventive and diagnostic care is covered at 100 percent. Plus, unlike many dental plans, BlueCare Dental HMO covers orthodontics for adults as well as children. You ll always know your copayment in advance and your out-of-pocket expenses will be lower with BlueCare Dental HMO than with other dental plans. Check your enrollment information for your specific copayments and benefit maximums. After you enroll, you ll receive additional information on your plan and a wallet card to show the dental office staff at your first visit. Visit our Web site at www.bcbsil.com 1
Benefits AN OVERVIEW Preventive and Diagnostic Care With full (100 percent) coverage for preventive and diagnostic care, you won t have to postpone receiving the preventive care that helps maintain your oral health. Regular dental checkups can help detect small problems early when they are most easily treated and before they require more costly and complicated procedures. The following preventive and diagnostic services are covered in full: dental examinations diagnostic x-rays two dental cleanings per benefit period fluoride treatments, sealants and space maintainers up to age 19 Primary Services Copayments for primary services vary depending on the complexity of the treatment. Primary services that are covered include, but are not limited to: fillings (amalgams and resins) oral surgery extractions (routine and surgical) root canals periodontal treatment (gingivectomy, osseous surgery, scaling and root planing) Major Services BlueCare Dental HMO also provides coverage for more extensive dental services, such as crowns, inlays/onlays, full and partial dentures and bridgework. You ll know the copayment for each procedure in advance. Check your dental benefit information for your specific copayments. 2 Visit our Web site at www.bcbsil.com
Emergency Care If you have an emergency, you can receive emergency care from any provider. You should first attempt to contact your primary care dentist or customer service at (800) 323-7201 and follow the directions you receive. In the event you cannot reach your dentist or customer service, you may seek emergency dental treatment from the nearest dentist. It is important to note that only services for palliative care (treatment for the relief of pain) will be covered. You are reimbursed up to $50 for care received from a dentist other than your primary care dentist. You make a modest copayment when you receive emergency care from your primary care dentist. Orthodontics Coverage includes consultations and treatment that includes full bands and retainers for a maximum of 24 months. Check your enrollment information for your orthodontics copayment. Provider Network When you join BlueCare Dental HMO, you select a primary care dentist who provides and coordinates your care for you, your spouse and all your eligible dependents. Remember, to receive your dental benefits, you must receive care from a participating primary care dentist. The BlueCare Dental HMO network also includes specialists such as oral surgeons, orthodontists, endodontists (specialists in diseases of the nerve in the tooth), periodontists (specialists in diseases of the gums and tissues) and pediatric dentists. If you need specialty care, your primary care dentist will refer you to a participating specialist. Each dentist and facility is credentialed before being accepted into the network. In addition, all participating dental offices undergo initial and periodic reviews that often include site visits. Customer Service Blue Cross is committed to providing excellent customer service. Specially trained BlueCare Dental HMO customer service representatives are available to help you. Just call (800) 323-7201 between 7:30 a.m. and 6:00 p.m. Monday through Friday (Central time). General information is available on our Web site at www.bcbsil.com. 3
Questions FREQUENTLY ASKED Can I continue to see my current dentist after I enroll? To receive dental coverage, your current dentist must be a member of the BlueCare Dental HMO provider network. You must select a participating dentist to provide and coordinate your care and the care of your dependents. What if I need to see a dental specialist? Your primary care dentist will refer you to an appropriate specialist from within the network. If there is no appropriate participating specialist within 35 miles of your home, your primary care dentist may refer you to a non-participating specialist. You must also call customer service to obtain prior authorization to see this specialist. If you receive care from a non-participating provider, you are responsible for the full cost. Can I change dentists after I enroll? Yes. You may choose another participating primary care dentist through the online dental provider list at www.bcbsil.com or from a printed directory available from your employer. You can also call customer service at (800) 323-7201 for assistance in making your transfer. Once you have made your selection, you can change your primary care dentist by completing the online selection form on our Web site. Provider changes made by the 20th of the month are effective the first day of the following month. How can I find a dentist convenient to where I work or live? Review the dental provider list on the Blue Cross Web site at www.bcbsil.com. You can even specify the number of miles you wish to travel and receive a map and directions. The online provider list is updated monthly. You can also call customer service at (800) 323-7201 or ask your employer to see a printed directory. 4 Visit our Web site at www.bcbsil.com What should I do if I need emergency dental care? Try to contact your BlueCare primary care dentist. If you cannot reach your dental office, call customer service at (800) 323-7201 and follow directions. If it is after business hours, leave a message and seek the care you need to relieve pain. Obtain an itemized bill and submit it to Blue Cross. You are eligible for reimbursement up to $50 for treatment for the relief of pain.
BlueCare Dental To enroll, see your employer for specific enrollment instructions. Welcome to the BlueCare Dental HMO Plan!
BlueCross BlueShield of Illinois EB4332 10/02 A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association