Dental Plan
Maintaining your healthy smile.
Your dental health is an important part of your overall wellness, which is why we offer dental coverage through Blue Cross Blue Shield of Illinois. You have two plan options to choose from so you can have the coverage that’s right for you. Both plans offer the same network of providers.
The dental plans cover preventive care (including regular checkups and two cleanings per calendar year), as well as fillings, bridges, crowns, and other dental services.
- PPO Network: Lowest cost to you with the largest discount applied to services
- Out-of-Network: Highest cost to you with no discounts on services; you pay the coinsurance plus any amounts over the difference in cost between the usual and customary charge and your out-of-network provider’s rate.
| BlueCare Dental High PPO | BlueCare Dental Low PPO | |||||
|---|---|---|---|---|---|---|
| PPO Network | Out-of-Network | PPO Network | Out-of-Network | |||
| ANNUAL DEDUCTIBLE | ||||||
| Individual | $50 | $75 | ||||
| Family | $150 | $225 | ||||
| ANNUAL MAXIMUM | ||||||
| Per Individual | $1,500 | $1,000 | ||||
| ORTHODONTIA LIFETIME MAXIMUM | ||||||
| Per Individual | $1,500 | $1,500 | ||||
| DIAGNOSTIC AND PREVENTIVE | ||||||
| Cleanings, Fluoride Treatments, Sealants, and X-rays—includes two cleanings per calendar year | 100% | 100% | 100% | 90% | ||
| BASIC SERVICES | ||||||
| Fillings, Periodontics, Scaling and Root Planning, and Oral Surgery | 90% | 80% | 80% | 60% | ||
| MAJOR SERVICES | ||||||
| Crowns, Bridges, Full, and Partial Dentures | 60% | 50% | 50% | 40% | ||
| Orthodontia (Child Only Up to Age 19) | 50% | 50% | 50% | 50% | ||
Visit bcbsil.com or call 800.367.6401.
