Blue Cross Blue Shield Supplement Policies Does It Pay for Dental

Dental Insurance Plans

Dependable and Affordable Dental Options for Individuals and Families

Did you know your dental health is linked to your overall health? Daily dental care and routine checkups can help you stay healthy. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) offers affordable dental plans in addition to great health care coverage.

Get Started

Blue Cross NC offers three dental plans to fit your budget and dental care needs. You can see what is covered for preventive, basic and major services in the What's Covered section below.

Which plan is right for you? With the two PPO plans you get richer benefits and better price points, in exchange for seeing dentists that are in the Blue Cross NC network. Individuals wanting to see a dentist who is not in the network may find the core plan to be a better fit.

Dental Blue for Individuals PPO:
Preventive Plan

Covers preventive services and savings on basic and major

Richer benefits in-network

^$23.86

Per Member, Per Month
regardless of age

Start Shopping

You pay 0% of in-network preventive care services and 0% of the allowed amount on out-of-network preventive care services after $20 copay¹

No deductible on in-network and $250 deductible on out-of-network basic and major services

You pay no more than 70% of the total bill for basic services – like routine fillings – when seeing an in-network dentist

You pay no more than 70% of the total bill for major services when seeing an in-network dentist

For out-of-network basic and major services, you pay a $250 deductible and most of the cost, including amounts above the allowed amount¹

Visit an in-network dentist for better benefits, and they will file the claims for you plus you won't have to pay charges over the allowed amount.

Find an In-Network Dentist

Note: This PPO plan will pay a higher benefit in-network. You may owe amounts above the allowed amount on out-of-network services.

Dental Blue for Individuals PPO 1500:
Value Plan

Covers preventive, basic and major services

Richer benefits in-network

^$34.45

Per Member, Per Month
under 65 years old

^$42.75

Per Member, Per Month
65 years or older

Start Shopping

You pay 0% of in-network preventive care services and 30% of the allowed amount on out-of-network preventive care services¹

$50 deductible in-network and $100 deductible on out-of-network basic and major services – $1500 annual maximum

You pay 20% of the negotiated rate for basic services – like routine fillings in-network and 50% of the allowed amount out-of-network

You pay 50% of the negotiated rate for major services when seeing an in-network dentist

For out-of-network major services, you pay 50% of the allowed amount and a $100 deductible

Visit an in-network dentist for better benefits, and they will file the claims for you plus you won't have to pay charges over the allowed amount.

Find an In-Network Dentist

Note: This PPO plan will pay a higher benefit in-network. You may owe amounts above the allowed amount on out-of-network services.

Dental Blue for Individuals:
Core Plan

Covers preventive, basic and major services

Same benefit level for contracted and non-contracted dentists

^$35.95

Per Member, Per Month
under 65 years old

^$44.35

Per Member, Per Month
65 years or older

Start Shopping

You pay 0% of the allowed amount on preventive care services¹

$75 deductible on basic and major services – $1000 annual maximum

You pay 30% of the allowed amount for basic services – like routine fillings

You pay 50% of the allowed amount for major services

While you pay the same percentage in- and out-of-network, you may owe on costs above the allowed amount out-of-network¹

Visit any dentist you want, but visiting an in-network dentist means they will file the claims for you and you won't have to pay charges over the allowed amount.

Find an In-Network Dentist

Note: This Core plan pays the same benefit percentage in- and out-of-network. You may owe amounts above the allowed amount on out-of-network services.

What's covered

Preventive

Basic

Major

Deductible for basic and major services

Annual Maximum – amounts that Blue Cross NC pays for preventive, basic and major services apply to the Annual Maximum

Waiting Periods²

Start Shopping

It's easy to apply for a dental insurance plan online.

ClickApply Now below
Enter some information about yourself
Submit your application

Apply Now

Already shopping for a Blue Cross NC health plan? Add a dental plan to your health plan application before submitting.

Need more help?

Read our Frequently Asked Questions below
Call us at 1-800-324-4973, Monday - Friday, 8 a.m. - 5 p.m.

Benefits of Buying a Blue Cross NC Plan

Plans are available in all 100 North Carolina counties

Checkups and cleanings are covered twice per benefit period

You can see any licensed dentist in North Carolina

There's no deductible for preventive care like routine checkups and cleanings¹

Choose the plan that best meets your needs

Start Shopping

How it Works

Using your dental insurance couldn't be easier:

Choose a licensed dentist practicing in North Carolina

Make an appointment

Show your Blue Cross NC member ID card at the dentist's office

Though most dentist offices will file a claim for you, if they don't offer that service, you will need to file the claim.

Start Shopping

Frequently Asked Questions

Who's eligible for Dental Blue® for Individuals℠?

All applicants (both under and over 65) and their dependents (spouses, domestic partners, and/or children under the age of 26) are eligible. Applicants must also be a resident of North Carolina and must have not had a Dental Blue for Individuals policy in the last 12 months.

Can I add a dependent to my dental plan?

Dependents can be added to your dental plan at any time, however standard waiting periods, if applicable, will apply.

Is it possible to cover my child but not myself?

Yes, you may apply for dental coverage that covers your child only.

If I cancel my Dental Blue for Individuals coverage, how soon can I reapply?

Reapplying for coverage isn't permitted for 12 months from your policy's termination date.

Are my monthly premiums subject to change?

You may experience a change in your monthly premiums at the time of your annual renewal (January 1 of each year), or when you add or remove dependents.

What are my premium payment options?

Your initial payment can be made by credit card or bank draft. Subsequent monthly premium payments can be set up for credit card, bank draft or direct bill.

How do I file a dental claim?

Participating providers will file the claim on your behalf. If your dentist office does not file claims, you should pay the dentist in full and submit your claim to Blue Cross NC for reimbursement. Complete a dental claim form and mail it to us within 180 days from the date of your service.

Download dental claim form

Mail the completed claim form to:

Blue Cross and Blue Shield of North Carolina
Dental Claims Unit
P.O. Box 2100
Winston-Salem, NC 27102-2100

Will I get credit for my prior dental coverage?

Yes, Blue Cross NC may waive or reduce any applicable dental waiting period by the number of month of prior dental coverage. Proof of prior dental coverage with less than 63 days lapse in coverage is required.

You must have had full coverage for preventive, basic and major services. Preventive only, Discount Only or Dental Savings Plans do not count as full coverage for prior credit. The DBFI PPO Preventive plan offers a benefit for preventive, basic and major services, therefore members who enroll in the DBFI PPO Preventive plan will earn coverage credit.

Can I change which dental plan I have anytime?

You can only change your dental plan within 60 days of a qualifying life event, like marriage, divorce, etc, or during the open enrollment period for January 1st renewals each year. Standard waiting periods, if applicable, will apply.

Start Shopping

Dental Blue for Individuals is not part of the covered health insurance benefits of any Blue Cross NC plans. Dental Blue for Individuals must be purchased separately.
Limitations and Exclusions - Dental Blue for Individuals
Your dental benefit plan does not cover services, supplies, drugs or charges that are:
1. Not clinically necessary
2. Hospitalization for any dental procedure
3. Dental procedures performed solely for cosmetic or aesthetic reasons, except when dental procedures are performed in order to restore normal function to minor children with congenital defects and anomalies
4. Dental procedure not directly associated with dental disease
5. Procedures not performed in a dental setting
6. Procedures that are considered to be experimental, including pharmacological regimens not accepted by the American Dental Association (ADA) Council on Dental Therapeutics
7. Placement of dental implants, implant-supported abutments and prostheses. This includes pharmacological regimens and restorative materials
8. Drugs or medications, obtainable with or without a prescription, unless they are dispensed and utilized in the dental office during the patient visit
9. Setting of facial bony fractures and any treatment associated with the dislocation of facial skeletal hard tissue
10. Treatment of malignant or benign neoplasm's, cysts, or other pathology, except excisional removal. Treatment of congenital malformations of hard or soft tissue, excluding excision. Hard or soft tissue biopsies of neoplasm's, cysts, or soft tissue growths of unknown cellular make-up are not excluded
11. Replacement of complete or partial dentures, fixed bridgework, or crowns within 8 years of initial or supplemental placement. This includes retainers, habit appliances, and any fixed or removable interceptive orthodontic appliances
12. Services related to the temporomandibular joint (TMJ), either bilateral or unilateral
13. Expenses for dental procedures begun prior to the member's eligibility with BCBSNC
14. Fixed or removable prosthodontic restoration procedures for complete oral rehabilitation or reconstruction
15. Attachments to conventional removable prostheses or fixed bridgework, including semi-precision or precision attachments associated with partial dentures, crown or bridge abutments, full or partial over dentures, any internal attachment associated with an implant prosthesis, and any elective endocentric procedure related to a tooth or root involved in the construction of a prosthesis of this nature
16. Procedures related to the reconstruction of a patient's correct vertical dimension of occlusion (VDO)
17. Denture relines for complete or partial conventional dentures are not covered for six months following the insertion of a prosthesis. Tissue conditioning and soft and hard relines for immediate full and partial dentures are not covered for six months after insertion of the full or partial denture. After this specified period, relines are covered once every 12 months.
18. One hard tissue periodontal surgery and one soft tissue periodontal surgery per surgical area are covered within a three-year period. This includes gingivectomy, gingivoplasty, gingival curettage (with or without a flap procedure), osseous surgery, pedicel grafts, and free soft tissue grafts
19. Osseous grafts, with or without resorbable or non-resorbable GTR membrane placement, are covered once every 36 months per quadrant or surgical site
20. Clinical situations that can be effectively treated by a more cost-effective, clinically acceptable alternative procedure will be assigned a benefit based on the less costly procedure
21. Services for incision and drainage if the involved abscessed tooth is removed on the same date of service
22. Full mouth debridement is limited to once every 5 years
23. Occlusal guards for any purpose other than control of habitual grinding
24. Placement of fixed bridgework solely for the purpose of achieving periodontal stability
25. Orthodontic services
Guaranteed Renewability: This policy is guaranteed renewable and may not be canceled or non-renewed for any reason other than your failure to pay premiums or misstatements in or omissions of information from your application. Any change in your rate will be preceded by a 30-day notice and is guaranteed for 12 months.
1

What we pay out-of-network providers is an "allowed amount," which is based on an average of our in-network contracted rates with participating providers. An allowed amount may be less than the provider's actual charge. You are responsible for charges above the allowed amount, in addition to any deductible and coinsurance applied.
2

Waiting periods can be reduced by the number of months of prior full dental coverage.
M60, 6/21
Y0079_10685_M CMS Accepted 10132021
U39086, 10/21

omalleytolde2001.blogspot.com

Source: https://www.bluecrossnc.com/shop-plans/dental-blue-individuals

Blue Cross Blue Shield Supplement Policies Does It Pay for Dental