pdent blue cross coverage

0000046543 00000 n Individuals attempting unauthorized access will be prosecuted. Also known as a computer-based patient record. If you are a BCBSTX STAR member and you would like to receive or learn more about dental services for adults ages 21 and older, please call DentaQuest directly for assistance. A group of healthcare providers that agrees to deliver coordinated care, meeting performance benchmarks for quality and affordability in order to manage the total cost of care for their member populations. A toll-free number, 1-800-676-BLUE, for healthcare providers to verify Blue Cross Blue Shield membership and coverage information for patients. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. H\n0. You pay 50% after deductible before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. If the member elects to receive care from BlueCare Dental network providers: If the member elects to receive care from providers outside of the network, they may choose: In addition, members have access to the BlueCare Dental ConnectionSMprogram. The group must also offer an alternate dental option to HMO. 0000012877 00000 n Dental PPO can be purchased as a stand-alone dental product or in conjunction with dental HMO. Learn more about dental services for adult STAR members. Blue Cross Blue Shield FEP Dental Limited to once every 24 months for primary teeth, and once every 48 months for permanent teeth. Now you can supplement your benefits with Accident, Critical Illness, and Hospital Recovery plans. PDF File is in portable document format (PDF). The plan features comprehensive and flexible options for coverage across three levelsGold, Silver, and Bronzeas well as some exciting new benefits that promote health equity in our province. A contract provision that allows either the MCO (managed care organization) or the provider to terminate the contract without providing a reason or offering an appeals process. A utilization management technique that requires a healthcare insurance plan member or the physician in charge of the member's care to notify the plan, in advance, of plans for a patient to undergo a course of care such as a hospital admission or complex diagnostic test. Register Now, Not registered? BlueCare Dental Connection integrates dental care management and health care management with a focus on preventive care and individual involvement. This all-ages dental plan covers 100 percent of preventive services like exams and cleanings when you see a Tier 1 PPO in-network dentist, and also helps cover care when you see a dentist who isnt in our preferred network. 0000075858 00000 n Teeth cleaning (prophylaxis) Class IV services are not covered. The site may also contain non-Medicare related information. This drug list is updated monthly. startxref Register Now. You are about to leave Blue Cross and Blue Shield of Alabama's website and enter a website operated by HealthEquity. The provision of mental health and chemical dependency (or substance abuse) services. Members fund their FSAs with contributions that come out of their paycheck. Also known as preventive care programs or wellness programs. When you partner with Blue Cross Blue Shield of Michigan, you're selecting the strongest network of providers in Michigan. Also known as a fee allowance, fee maximum or capped fee. Our BlueCare DentalSM program offers two network-based dental products. 0000002644 00000 n Allowed amount The contracted rate, or "Blue Cross discount," set by your plan and providers when you see in-network hospital, clinics or pharmacies . Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2022- 12/31/2022 Anthem Blue Cross: PORAC Prudent Buyer PPO Plan Coverage for: Individual + Family | Plan Type: PPO CA/L/A/CalPERS PPOC20800:PORACPrudentBuy-PPO/NA/UQBHJ/NA/01-22 1 0000021620 00000 n premium table below. 0000107951 00000 n endstream endobj 8 0 obj <> endobj 6129 0 obj <> endobj 6130 0 obj <> endobj 838 0 obj <> endobj 2595 0 obj <>/K 1115 0 R/ParentTree 2597 0 R/ParentTreeNextKey 138/RoleMap 2695 0 R/Type/StructTreeRoot>> endobj 2596 0 obj <>/A0+1<>/A0_1<>/A1<>/A1+1<>/A1+2<>/A10<>/A10+1<>/A10_1<>/A11<>/A11+1<>/A11_1<>/A12<>/A12+1<>/A12+2<>/A12_1<>/A13<>/A13+1<>/A14<>/A15<>/A17<>/A2<>/A2+1<>/A2+2<>/A20<>/A3<>/A3+1<>/A4<>/A4+1<>/A4_1<>/A5<>/A5+1<>/A5_1<>/A6<>/A6+1<>/A6_1<>/A7<>/A7_1<>/A8<>/A8+1<>/A9<>/CM1<>/CM1+1<>/CM1+2<>/CM1+3<>/CM10<>/CM10+1<>/CM10+2<>/CM10+3<>/CM11<>/CM11+1<>/CM11+2<>/CM11+3<>/CM12<>/CM12+1<>/CM12+2<>/CM12+3<>/CM13<>/CM13+1<>/CM13+2<>/CM14<>/CM14+1<>/CM14+2<>/CM15<>/CM15+1<>/CM16<>/CM16+1<>/CM17<>/CM18<>/CM2<>/CM2+1<>/CM2+2<>/CM2+3<>/CM3<>/CM3+1<>/CM3+2<>/CM3+3<>/CM4<>/CM4+1<>/CM4+2<>/CM4+3<>/CM5<>/CM5+1<>/CM5+2<>/CM5+3<>/CM6<>/CM6+1<>/CM6+2<>/CM6+3<>/CM7<>/CM7+1<>/CM7+2<>/CM7+3<>/CM8<>/CM8+1<>/CM8+2<>/CM8+3<>/CM9<>/CM9+1<>/CM9+2<>/CM9+3<>/Pa0<>/Pa0+1<>/Pa0_1<>/Pa1<>/Pa1+1<>/Pa10<>/Pa10+1<>/Pa10_1<>/Pa11<>/Pa11+1<>/Pa11+2<>/Pa11_1<>/Pa12<>/Pa12+1<>/Pa12_1<>/Pa13<>/Pa13_1<>/Pa14<>/Pa14_1<>/Pa15<>/Pa15+1<>/Pa16<>/Pa16+1<>/Pa16_1<>/Pa17<>/Pa17_1<>/Pa18<>/Pa18_1<>/Pa19<>/Pa19_1<>/Pa2<>/Pa2+1<>/Pa20<>/Pa21<>/Pa21_1<>/Pa24<>/Pa25<>/Pa26<>/Pa28<>/Pa3<>/Pa3+1<>/Pa30<>/Pa4<>/Pa4+1<>/Pa5<>/Pa5+1<>/Pa5+2<>/Pa6<>/Pa6+1<>/Pa6_1<>/Pa7<>/Pa7+1<>/Pa7+2<>/Pa7_1<>/Pa8<>/Pa8_1<>/Pa9<>/Pa9+1<>/Pa9_1<>>> endobj 1115 0 obj <> endobj 2597 0 obj <><>]>> endobj 2695 0 obj <> endobj 2132 0 obj <>1036]/P 2131 0 R/Pg 997 0 R/S/Link>> endobj 2077 0 obj <>991]/P 2076 0 R/Pg 987 0 R/S/Link>> endobj 2033 0 obj <>990]/P 2031 0 R/Pg 987 0 R/S/Link>> endobj 2061 0 obj <>988]/P 2060 0 R/Pg 987 0 R/S/Link>> endobj 2212 0 obj <><>]/P 2211 0 R/Pg 972 0 R/S/P>> endobj 2580 0 obj <>1240]/P 2579 0 R/Pg 1008 0 R/S/Link>> endobj 1244 0 obj <>280 281 282]/P 1243 0 R/Pg 927 0 R/S/Link>> endobj 1242 0 obj <>263 264]/P 1241 0 R/Pg 927 0 R/S/Link>> endobj 1223 0 obj <>255 256 257]/P 1222 0 R/Pg 927 0 R/S/Link>> endobj 1211 0 obj <>167 168 169]/P 1210 0 R/Pg 910 0 R/S/Link>> endobj 1160 0 obj <>73]/P 1159 0 R/Pg 849 0 R/S/Link>> endobj 1159 0 obj <> endobj 849 0 obj <. %PDF-1.4 % 0000028804 00000 n %%EOF Group Dental Plans | Blue Cross and Blue Shield of Oklahoma - BCBSOK Once youve reached this out-of-pocket maximum, your plan pays 100 percent of the allowed amount. 0000014199 00000 n Member Discounts Take advantage of member-only discounts on health-related products and services. The practice of an insurance company underwriting a number of small groups as if they constituted one large group. %PDF-1.4 % 0000005103 00000 n 0000003118 00000 n There is no waiting period for Class I services. trailer <<52597CAB61384F8F8DEED1C6F907D3A3>]/Prev 159881>> startxref 0 %%EOF 63 0 obj <>stream This new site may be offered by a vendor or an independent third party. To view this file, you may need to install a PDF reader program. 0000017747 00000 n 44 0 obj <> endobj The integration of financing and delivery of healthcare within a system that seeks to manage the accessibility, cost and quality of that care. 00421 It identifies the member's Blue Cross Blue Shield company or national account in order to properly route the claim. An information system that incorporates membership data and provider reimbursement arrangements and analyzes transactions according to contract rules. %PDF-1.6 % Is your health coverage changing. 0000029289 00000 n BlueCare Dental PPO | Blue Cross and Blue Shield of Texas - BCBSTX 0000013821 00000 n Covered once per arch every 84 months. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. Get access to your employer portal.Register Now, Not registered? A process in which a healthcare organization undergoes an evaluation of its operating procedures to determine whether the procedures meet designated criteria as defined by the accrediting body, and to ensure that the organization meets a specified level of quality. HMO, PPO, EPO, POS: Which Plan Is Best? - Verywell Health 0000000016 00000 n See the chart on the back for more plan details. You may also ask us for a coverage determination by phone at 1-888-285-2249 (TTY:711), We are open 8 a.m. - 8 p.m., local time, 7 days a week. To give you an accurate price, we'll need some information. Oral surgery 0000007922 00000 n 0000006632 00000 n 2020-09-09T21:17:19-07:00 A set of specialized healthcare services that provide support to terminally ill patients and their families. - Coverage for children up to the end of the month in which the member turns 19. . endstream endobj 68 0 obj <> endobj 69 0 obj <> endobj 70 0 obj <> endobj 71 0 obj <> endobj 72 0 obj <> endobj 73 0 obj <>stream Fillings A utilization and quality management mechanism designed to aid providers in making decisions about the most appropriate course of treatment for a specific clinical case. Programs designed to educate and motivate members to prevent illness and injury and to promote good health through lifestyle choices, such as smoking cessation and dietary changes. Oral health touches every aspect of our lives but is often taken for granted. A process through which an organization validates credentialing information from the organization that originally conferred or issued the credentialing element to the practitioner. Get access to your online account.Register Now, Not registered? Root canals To learn more about dental benefits for STAR children, see the STAR Member Handbook. (Coverage is not available for non-network dentists in Massachusetts except for covered emergency services.) Not registered? In addition, some sites may require you to agree to their terms of use and privacy policy. 0000053119 00000 n Any dental plan offered by an organization that provides a benefit plan that differs from a traditional fee-for-service plan. Ottawa. June 17, 2022 . The content on the Dental Wellness Center website is provided by go2dental.com, Inc. (go2dental.com). 0000070270 00000 n We want you to be informed so that you can get the most appropriate and cost-effective care. For more information, please contact your account executive at 1-505-837-8787 or toll-free at 1-800-672-9700. They are not balance billed Network providers will not bill for costs that are in excess of the BCBSTX allowable amount for covered services. 0000017596 00000 n The direct care provider is in the same physical location as the member and offers care to patients from within the local Plan's service area. HealthEquity has . 0000001276 00000 n With BlueCare Dental PPO, you'll get: One of the highest maximum annual benefit levels available - up to $1,500 per person per year Up to a 20% discount, up to a maximum savings of $1,000 for orthodontic services at participating dentists For more information on coverage and benefits, view the BlueCare Dental Outline of Coverage Sinema Applauds Dignity Health and Blue Cross Blue Shield for Reaching 0000009079 00000 n A benefit payment system in which an insurer reimburses the group member or pays the provider directly for each covered medical expense after the expense has been incurred. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred. In addition, some sites may require you to agree to their terms of use and privacy policy. 0 Preventive care like exams and cleanings. This out-of-pocket maximum is the most youll have to pay during a calendar year for covered pediatric dental services. Introducing our new Health and Dental plan 0000049503 00000 n A doctor, hospital or other healthcare entity enrolled in a network of designated PPO providers. Individual & Family Health Insurance Plans | Anthem Cleanings are covered twice a year. In addition, some sites may require you to agree to their terms of use and privacy policy. These budget-friendly insurance options help lessen the financial impact of unexpected health care costs. 0000050197 00000 n 0000036033 00000 n A method of planning and implementing quality management programs that consists of identifying the best practices and best outcomes for a specific process and emulating the best practices to equal or surpass the best outcomes. After reaching that limit for the year, you pay for 100% of your dental care. For all of your dental questions and/or claim forms, please contact your local Blue Cross Blue Shield company. 2. 0000005867 00000 n To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. A voluntary health insurance program for federal employees, retirees and their dependents and survivors. 211 is the source Canadians trust when seeking information. Allows members to use pre-tax dollars for certain eligible medical and dependent care expenses. These cards assist PBMs in processing and tracking pharmaceutical claims. Fillings and sealants. Dental Coverage | Blue Cross and Blue Shield of Texas - BCBSTX 0000001876 00000 n pdent blue cross coverage. These documents also show your estimated costs for two sample medical events: having a baby and managing diabetes. Traditional insurance offers the most freedom of choice and control over healthcare, but benefits are maximized when using a participating Blue Cross Blue Shield company. The Patient Protection and Affordable Care Act (commonly called the ACA) was signed into law in 2010 to address access, quality and cost in the healthcare industry. Established by the Balanced Budget Act, this program is designed to provide health assistance to uninsured, low-income children either through separate programs or through expanded eligibility under state Medicaid programs. The name Affordable Care Act refers to the final, amended version of the law. Any additional costs are paid by the member out of pocket. It is focused on preventive care and the treatment of routine injuries and illnesses. Adult members are age 19 or older at the start of the coverage year. A dental service plan that allows a member to use either a dental health maintenance organizations (DHMO) network dentist or to seek care from a dentist not in the health maintenance organization's (HMO) network. If you have any questions or comments regarding the Dental Wellness Center website, you should direct them to go2dental.com, Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). However, the lower benefit plan level will apply and out-of-pocket expenses will be higher when receiving dental services from dentists not in the BlueCare DentalSM network. Members can find information aboutagent commissions. 0000069257 00000 n 0000059838 00000 n A flat amount the member must pay before the insurer will make any benefit payments. 100% coverage for periodontal cleanings to members with specific health issues at no additional cost. A federal law that outlines the requirements that employer-sponsored group insurance plans, insurance companies and managed care organizations must satisfy in order to provide health insurance coverage to individuals and groups. A medical care center that provides a wide range of healthcare services, including preventive care, acute care, surgery and outpatient care, in a centralized facility. A company that is owned by its members or policyowners. 0000055048 00000 n BlueCare Dental is a portfolio of standard dental preferred provider option (PPO) benefit plan designs BlueCare Dental Freedom SM and BlueCare Dental Choice SM. These services are covered six months after you first join a Blue Dental plan. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Copyright 2022Health Care Service Corporation. 0000002422 00000 n Register Now, Not registered? . What is Pdent? - Shabupc.com 1996-2022 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. BlueCard Access assists members who need a referral to a physician or healthcare facility in another location. 2023 Blue Dental SM PPO 100/50/50 This all-ages dental plan covers 100 percent of preventive services like exams and cleanings when you see a Tier 1 PPO in-network dentist, and also helps cover care when you see a dentist who isn't in our preferred network. Allows members to save money into tax-advantaged accounts. Search for Doctors, Hospitals and Dentists Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. * Blue Cross and Blue Shield of Illinois (BCBSIL) is providing access to the Dental Wellness Center website as a courtesy, as part of its BlueCare Dental Connection program. Identification cards issued by a pharmacy benefit management plan (PBM) to plan members. A type of Health Benefit Plan that allows members to go outside the network for non-emergency care, but may result in a lower level of benefits being paid by the Health Benefit Plan. Sealants 0000115092 00000 n One option is Adobe Reader which has a built-in reader. trailer 4 Blue Cross Blue Shield of Massachusetts, P.O. Have us call you by filling outthis online form. collect outside the U.S. BCBS FEP Dental has a larger nationwide network with nearly half a million provider access points. Our AskBlue. H\n0E Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. BCBSIL Mobile - Coverage These services are covered 12 months after you first join a Blue Dental plan. 0000088585 00000 n PScript5.dll Version 5.2.2 0000047131 00000 n Adult BCBSTX STAR members aged 21 and older are eligible to receive dental services as a Value-Added Services. If you're considering enrolling in one of our individual and family plans, learn a bit more about the coverage you'll receive. 0000076479 00000 n DentaQuest can help members find in-network providers and get authorizations for dental services. All Rights Reserved. TTY users dial 711. This all-ages dental plan covers 100 percent of preventive services like exams and cleanings when you see one of those in-network dentists.

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