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The City provides all benefits-eligible employees with one free annual exam, one cleaning and one set of bite-wing x-rays per year, at no cost when you visit a BlueCross BlueShield DentalBlue provider.

Employees also have the option to purchase more comprehensive dental coverage for themselves and their families.


Choose from these 3 buy-up options provided through BlueCross BlueShield:

• A Base-Plus dental option, which provides preventive and basic services only to you and your dependents
• A Low dental option, which provides preventive, basic and major services with a $1,500 annual maximum
• A High dental option, which also includes orthodontia, up to a $2,000 annual maximum 
 


BCBST BUY-UP OPTIONS

Whether you elect the Base Plus, Low or the High option, you are free to visit any provider you choose. The benefit percentages are the same for in and out of network, but the difference is you could be balance billed if you see a non-network provider.  As long as you use a dentist in BlueCross BlueShield's DentalBlue network, you will not be billed for charges exceeding the maximum plan allowance. See the chart and footnotes below, or visit www.BCBST.com to locate network providers.

In addition, all options cover additional exams/cleanings (up to three per year) for diabetics and pregnant women with periodontal disease, individuals with renal failure or suppressed immune systems, head and neck radiation patients, and individuals at risk for infective endocarditis.



DENTAL OPTIONS AT A GLANCE


  BCBST Base Plus Option  BCBST 
Low Option
BCBST
High Option
 
YOU PAY
Calendar Year Deductible $50/individual $150/family $50/individual $150/family $50/individual
$150/ family
THEN THE PLAN PAYS
Preventive care (exams, x-rays, cleanings) 100%
no deductible 
Does not apply towards Annual Max
100%
no deductible
Does not apply towards Annual Max
100%
no deductible
Does not apply towards Annual Max
Basic care (fillings) 80% 
after deductible
80% 
after deductible
80% 
after deductible
Major care (crowns, dentures, bridges oral surgery, endo and perio) None 50% 
after deductible
50%
after deductible
Orthodontia None None 50%
no deductible
Child only to age 19
Annual benefit maximum  $1,000 $1,500 $2,000
Orthodontia lifetime maximum N/A N/A $2,000

(1) Providers in BCBST's DentalBlue Network have agreed not to accept the BCBST allowable rate. If you use providers outside this network, you're responsible for charges exceeding the 90th percentile of UCR.