Date: April 27, 2018 Market: Dental, 2-50 and 51+ DHMO Prvider Chice Prduct Exit, 2-50 and 51+ Maryland and Virginia Only Beginning with July 2018 renewals, DHMO Prvider Chice (PC) plans will be discntinued fr 2-50 and 51+ grups in Maryland and Virginia. The prduct exit impacts 120 grups with 2,152 subscribers (3,596 members). D.C. grups will cntinue t renew as scheduled until further ntice. Cmmunicatins MD and VA grups will receive a ntificatin letter 60 days prir t their renewal date. Fr example, grups renewing July 1, 2018 will receive a letter by r befre May 1, 2018. Maryland, sample letter Virginia, sample letter Members in VA will als receive a discntinuatin letter 45 days prir t their terminatin date. Fr example, grups renewing July 1, 2018 will receive a letter by r befre May 15, 2018. Alternate Dental Plans Prir t their renewal date, these grups will autmatically receive a qute fr an alternative BlueDHMO plan (see attached) with benefits similar t their existing DHMO PC plan. Grups will nt autmatically be renewed int a new plan; emplyers must sign the new dental qute in rder t enrll in the new plan. If a grup s nly line f cverage with CareFirst is the DHMO PC plan and they d nt select an alternate BlueDHMO prduct (r any ther plan), the grup will be terminated. A grup can nly have ne BlueDHMO prduct. If the grup already has BlueDHMO, anther BlueDHMO prduct will nt be quted. CareFirst BlueCrss BlueShield is the shared business name f CareFirst f Maryland, Inc. and Grup Hspitalizatin and Medical Services, Inc. CareFirst f Maryland, Inc., Grup Hspitalizatin and Medical Services, Inc., CareFirst BlueChice, Inc., The Dental Netwrk and First Care, Inc. are independent licensees f the Blue Crss and Blue Shield Assciatin. In the District f Clumbia and Maryland, CareFirst MedPlus is the business name f First Care, Inc. In Virginia, CareFirst MedPlus is the business name f First Care, Inc. f Maryland (used in VA by: First Care, Inc.). Registered trademark f the Blue Crss and Blue Shield Assciatin.
When exiting these lder DHMO prducts, CareFirst ffers a wide variety f alternative DHMO and PPO dental plans: BlueDHMO $0 and BlueDHMO $10 ffice visit plans: The same netwrk access as the current plan with updated member fee schedules. These plans are available as vluntary, r emplyer spnsred Minimum enrllment f tw cntracts; n minimum percentage Can be ffered alng with ther CareFirst dental prducts if grup has at least tw medical plans Reginal netwrk access BlueDental Basic: A lw-cst plan ffering expanded netwrk access Limited cvered services include diagnstic, preventative and basic services N cst diagnstic & preventative services (in-netwrk) Only emplyer spnsred ptin at this time Brad netwrk access Natinwide netwrk access BlueDental Plus: A cmprehensive prtfli f plan ptins N cst diagnstic & preventative services (in-netwrk) Emplyer spnsred r vluntary Brad netwrk access Shuld yu have any questins, please cntact yur brker sales representative. 2
Dear Grup Administratr: In rder t ensure we are delivering the prducts, benefits and services ur custmers mst desire, we peridically review ur dental prduct ffering. As a result f a recent evaluatin, CareFirst BlueCrss BlueShield, CareFirst BlueChice, Inc. and The Dental Netwrk (CareFirst) will n lnger ffer the DHMO Prvider Chice dental plan. Yu will nt be able t renew this plan at yur next renewal date. Yu will autmatically receive a qute fr an alternative BlueDHMO plan with benefits similar t thse yu currently ffer, thugh benefits and rates may vary. In additin, ther CareFirst dental plans ptins are available t ffer t yur emplyees and yu can get infrmatin and rates fr thse plans, as well. If yu have any questins n alternative dental plans, please cntact yur CareFirst sales representative. We appreciate yur business and lk frward t cntinuing t d business with yu. Thanks, Tny Taylr CareFirst BlueCrss BlueShield Sr. Directr, Dental Operatins & Sales Cnsulting CareFirst BlueCrss BlueShield is the shared business name f CareFirst f Maryland, Inc. and Grup Hspitalizatin and Medical Services, Inc. CareFirst f Maryland, Inc., Grup Hspitalizatin and Medical Services, Inc., CareFirst BlueChice, Inc. and The Dental Netwrk are independent licensees f the Blue Crss and Blue Shield Assciatin. Registered trademark f the Blue Crss and Blue Shield Assciatin. Registered trademark f CareFirst f Maryland, Inc.
Dear Grup Administratr: In rder t ensure we are delivering the prducts, benefits and services ur custmers mst desire, we peridically review ur dental prduct ffering. As a result f a recent evaluatin, CareFirst BlueCrss BlueShield and CareFirst BlueChice, Inc. (CareFirst) will n lnger ffer the DHMO Prvider Chice dental plan. Yu will nt be able t renew this plan at yur next renewal date. Yu will autmatically receive a qute fr an alternative BlueDHMO plan with benefits similar t thse yu currently ffer, thugh benefits and rates may vary. In additin, ther CareFirst dental plans are available t ffer t yur emplyees and yu can get infrmatin and rates fr thse plans, as well. If yu have any questins n alternative dental plans, please cntact yur CareFirst sales representative. CareFirst will be ntifying yur emplyees 45 days prir t yur renewal date that their plan will nt be available upn renewal. We appreciate yur business and lk frward t cntinuing t d business with yu. Thanks, Tny Taylr CareFirst BlueCrss BlueShield Sr. Directr, Dental Operatins & Sales Cnsulting CareFirst BlueCrss BlueShield is the business name f Grup Hspitalizatin and Medical Services, Inc. Grup Hspitalizatin and Medical Services, Inc. and CareFirst BlueChice, Inc. are independent licensees f the Blue Crss and Blue Shield Assciatin. Registered trademark f the Blue Crss and Blue Shield Assciatin.
Dear Member: In rder t ensure we are delivering the prducts, benefits and services ur members mst desire, we peridically review ur dental prduct ffering. As a result f a recent evaluatin, CareFirst BlueCrss BlueShield and CareFirst BlueChice, Inc. (CareFirst) will n lnger ffer the DHMO Prvider Chice dental plan. This plan will nt be available t yu during yur next renewal. Yur Benefits Manager will let yu knw what plan(s) if any, will be ffered prir t pen enrllment. If yu have any questins regarding this, please cntact yur Benefits Manager. Thank yu, Tny Taylr CareFirst BlueCrss BlueShield Sr. Directr, Dental Operatins & Sales Cnsulting CareFirst BlueCrss BlueShield is the business name f Grup Hspitalizatin and Medical Services, Inc. Grup Hspitalizatin and Medical Services, Inc. and CareFirst BlueChice, Inc. are independent licensees f the Blue Crss and Blue Shield Assciatin. Registered trademark f the Blue Crss and Blue Shield Assciatin.
Plan Cmparisn: DHMO PC-5 and BlueDHMO $0 DHMO PC-5 BlueDHMO $0 Service Cpay Basic Dental Services (per ffice visit cpay) $5 $0 Sft Tissue Management (per ffice visit cpay) Peridntal scaling and rt planing $60 $60 Full muth debridement $60 $50 Peridntal maintenance prcedures fllwing active therapy $60 $40 Restrative Services Crwn - prcelain fused t predminantly base metal $300 $330 Crwn - prcelain fused t high nble metal $320 $350 Enddntics - Rt Canal Therapy Aterir (excluding final restratin) $190 $190 Mlar (excluding final restratin) $310 $310 Dentures and Related Prcedures Cmplete denture - maxillary r mandibular $320 $335 Partial dental - cast metal framewrk with resin denture bases $350 $385 Reline cmplete maxillary r mandibular denture (in a dentist's ffice) $75 $80 Pntic - prcelain fused t predminantly base metal $300 $300 Pntic - prcelain fused t high nble metal $320 $320 Surgical Services Osseus Surgery (including flap entry and clsure) per quadrant $330 $330 Surgial remval f erupted tth $60 $65 Remval f impacted tth - cmpletely bny $120 $120 Orthdntics Cmprehensive - adlescent $2,100 $3,000 Cmprehensive - adult $2,250 $3,000 Pre-rthdntic treatment visit $120 $70 Orthdntic retentin $190 $190 Anesthesia (intravaneus sedatins - first 30 minutes) $90 $100 Brken Appintment Fee (withut 24 hur ntice) $10 (per 15 minutes) $40 This chart includes cmmn prcedures and des nt list all services and prcedures cvered by the benefits cntract. It is fr cmparisn purpses nly and des nt create rights that are nt cvered thrugh the benefit plan.
Plan Cmparisn: DHMO PC-10 and BlueDHMO $10 DHMO PC-10 BlueDHMO $10 Service Cpay Basic Dental Services (per ffice visit cpay) $10 $10 Sft Tissue Management (per ffice visit cpay) Peridntal scaling and rt planing $65 $65 Full muth debridement $65 $55 Peridntal maintenance prcedures fllwing active therapy $65 $45 Restrative Services Crwn - prcelain fused t predminantly base metal $370 $410 Crwn - prcelain fused t high nble metal $390 $430 Enddntics - Rt Canal Therapy Aterir (excluding final restratin) $250 $250 Mlar (excluding final restratin) $410 $410 Dentures and Related Prcedures Cmplete denture - maxillary r mandibular $410 $415 Partial dental - cast metal framewrk with resin denture bases $435 $480 Reline cmplete maxillary r mandibular denture (in a dentist's ffice) $90 $100 Pntic - prcelain fused t predminantly base metal $370 $370 Pntic - prcelain fused t high nble metal $390 $390 Surgical Services Osseus Surgery (including flap entry and clsure) per quadrant $400 $400 Surgial remval f erupted tth $75 $75 Remval f impacted tth - cmpletely bny $160 $160 Orthdntics Cmprehensive - adlescent $2,300 $3,000 Cmprehensive - adult $2,450 $3,000 Pre-rthdntic treatment visit $130 $100 Orthdntic retentin $200 $200 Anesthesia (intravaneus sedatins - first 30 minutes) $110 $125 Brken Appintment Fee (withut 24 hur ntice) $10 (per 15 minutes) $40 This chart includes cmmn prcedures and des nt list all services and prcedures cvered by the benefits cntract. It is fr cmparisn purpses nly and des nt create rights that are nt cvered thrugh the benefit plan.
Plan Cmparisn: DHMO PC-20 and BlueDHMO $10 DHMO PC-20 BlueDHMO $10 Service Cpay Basic Dental Services (per ffice visit cpay) $20 $10 Sft Tissue Management (per ffice visit cpay) Peridntal scaling and rt planing $70 $65 Full muth debridement $70 $55 Peridntal maintenance prcedures fllwing active therapy $70 $45 Restrative Services Crwn - prcelain fused t predminantly base metal $410 $410 Crwn - prcelain fused t high nble metal $450 $430 Enddntics - Rt Canal Therapy Aterir (excluding final restratin) $300/$400* $250 Mlar (excluding final restratin) $450/$600* $410 Dentures and Related Prcedures Cmplete denture - maxillary r mandibular $485 $415 Partial dental - cast metal framewrk with resin denture bases $540 $480 Reline cmplete maxillary r mandibular denture (in a dentist's ffice) $115 $100 Pntic - prcelain fused t predminantly base metal $410 $370 Pntic - prcelain fused t high nble metal $450 $390 Surgical Services Osseus Surgery (including flap entry and clsure) per quadrant $420/$600* $400 Surgial remval f erupted tth $80/$110* $75 Remval f impacted tth - cmpletely bny $165/$200* $160 Orthdntics Cmprehensive - adlescent $2,500 $3,000 Cmprehensive - adult $2,700 $3,000 Pre-rthdntic treatment visit $150 $100 Orthdntic retentin $250 $200 Anesthesia (intravaneus sedatins - first 30 minutes) $150 $125 Brken Appintment Fee (withut 24 hur ntice) $10 (per 15 minutes) $40 *When tw cpays are listed, the primary dentist will prvide the service at the lwer amunt and the specialty care dentist will prvide the service at the higher amunt. This chart includes cmmn prcedures and des nt list all services and prcedures cvered by the benefits cntract. It is fr cmparisn purpses nly and des nt create rights that are nt cvered thrugh the benefit plan.