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.