|
v
Home
Tonik Health
Right Plan PPO 40
Dental Insurance
Short Term Coverage
HMO Plans
Individual & Family Plans
HSA Compatible Plan
Find a Doctor
Quick Quote
Agent
Info
Apply Online
SmileNet Dental
Discount Program
Download or Request Brochure or Application
Certified Financial Consultants
seal Beach, CA 90740
(562) 431-5575
G. William Moore
CLU, ChFC
CA Ins. Lic.
# 0707682
|
Blue Cross Individual PPO Dental Insurance Plan
from BC Life and Health Insurance
Company
-
Freedom to choose any dentists
-
Access to quality care at discounted
fees
-
Services at negotiated rates
-
Wide range of dental and specialty
services
-
Large network of over 12,000
professionals
When you use a participating dentist,
you'll receive valuable benefits at lower Blue Cross-negotiated fees. This
means no office co-pays for specified services, no waiting periods or office
co-pays for preventive and diagnostic care, no deductible for preventive and
diagnostic care such as regular checkups, cleaning and X-rays, and a low $50
annual deductible per member.
Preventive and Diagnostic Care
No waiting periods and deductible is waived at
Participating Dentists |
| |
At Participating
Dentists
the plan pays |
At a Non-Participating Dentist
the plan pays |
Periodic oral exam
limited to two per member per year |
100 % |
$18 |
|
Comprehensive oral exam |
100 % |
$25 |
| Bitewing X-rays -
single film |
100 % |
$16 |
| Bitewing X-rays -
two films |
100 % |
$18 |
|
Single (Periapical) X-rays
first film
additional films |
100 %
100 % |
$13*
$8* |
| Bitewing X-rays -
four films |
100 % |
$26* |
Full mouth X-rays
limited to one set every 3 years |
100 % |
$60 |
| Routine cleaning
- adult limited to two per year |
100 % |
$39 |
| Routine cleaning
- child limited to two per year |
100 % |
$30 |
Cleaning with fluoride
limited to two per child per year |
100 % |
$35 |
Topical fluoride only
limited to two per child per year |
100 % |
$14 |
* Total benefit for single
and bitewing X-rays, not to exceed cost of full mouth
-$60 at non-participating dentists |
| Basic
Dental Care - coverage begins after the policy has been
in effect for three continuous months |
| Benefit |
At Participating or
Non-Participating Dentists the plan pays |
| Filings -
one surface/two surfaces/three surfaces/four or more
surfaces |
$42/ $55/ $72/ $84 |
| Extraction -
erupted tooth or root |
$49 |
| Surgical extraction
- removal of erupted tooth |
$84 |
Removal of impacted tooth
-
soft tissue/partial bony/complete bony |
$111/ $148/ $180 |
|
Major Dental Care -
coverage begins after the policy has been in effect for
three continuous months |
| Benefit |
At Participating or
Non-Participating Dentists the plan pays |
| Scaling/root
planing - per quadrant |
$48 |
Gingivectomy
- one to three teeth per quadrant/
four or more contiguous teeth per quadrant |
$40/
$145 |
Osseous
surgery - per quadrant
paid at $62 per tooth to a maximum of $277/quadrant |
$277 |
| Root canal-
one canal |
$154 |
| Root canal-
two canal |
$189 |
| Root canal-
three canal |
$242 |
| Crown
(except stainless steel) |
$264 |
| Stainless
steel crown |
$57 |
| Pontic |
$264 |
| Post and
core - in addition to crown |
$75 |
| Dentures |
complete upper and lower |
$343 |
|
partial upper or lower |
$308 |
|
reline chairside |
$75 |
|
reline lab |
$106 |
Dental PPO rates
To
Apply Online
For more complete information, please download brochure with
application.
Dental Select HMO Plan
4b
|
