Dental Plan

Two dental plan options through BCBSIL.

Both cover diagnostic and preventive care at 100%, but differ in other ways.

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Your Choice Overview

DENTAL HMO	DENTAL PPO
See a network dentist or pay the full cost of care	See any dentist you choose but see greater benefits when you stay in network
Preventive and diagnostic procedures covered at 100%
Orthodontia coverage included but varies by plan

Dental Plans at a Glance

	In-Network Dental Coverage Details
	Per Pay Period Cost	Diagnostic & Preventive	Annual Deductible	Annual Maximum Benefit (per person)	Basic Restorative	Major Restorative	Orthodontia
Dental HMO*	Employee Only: $5.35 Employee + 1 Dependent: $10.01 Employee + Family: $16.74	100% covered, no deductible	$0 $0 $0	None	Copays vary based on services needed
Dental PPO	Employee Only: $12.80 Employee + 1 Dependent: $30.82 Employee + Family: $38.42	100% covered, no deductible	Employee Only: $50 Employee + 1 Dependent: $100 Employee + Family: $150	$1,500	You pay 20% after deductible	You pay 50% after deductible	50% coinsurance, $1,500 per member lifetime maximum

*This plan only covers services within its network of providers. If you choose to go out of network, you will pay the full cost of care.

Your Choice Overview

See a network dentist or pay the full cost of care

Preventive and diagnostic procedures covered at 100%

Orthodontia coverage included but varies by plan

See any dentist you choose but see greater benefits when you stay in network

Preventive and diagnostic procedures covered at 100%

Orthodontia coverage included but varies by plan

Dental Plans at a Glance

Select the tab for each plan to review the details.

In-Network Dental Coverage Details
Diagnostic & Preventive	100% covered, no deductible
Annual Deductible	$0 $0 $0
Annual Maximum Benefit (per person)	None
Basic Restorative	Copays vary based on services needed
Major Restorative	Copays vary based on services needed
Orthodontia	Copays vary based on services needed

In-Network Dental Coverage Details
Diagnostic & Preventive	100% covered, no deductible
Annual Deductible	Employee Only: $50 Employee + 1 Dependent: $100 Employee + Family: $150
Annual Maximum Benefit (per person)	$1,500
Basic Restorative	You pay 20% after deductible
Major Restorative	You pay 50% after deductible
Orthodontia	50% coinsurance, *$1,500 per member lifetime maximum*

*This plan only covers services within its network of providers. If you choose to go out of network, you will pay the full cost of care.

How to Get the Most from Your Dental Benefits

Choose in-network providers

Call a BCBSIL Health Advocate at (855) 418-9393 or look online for a BCBSIL dentist.

Enrolled in Dental HMO?
This plan does not cover out-of-network care, so you must use in-network providers. Choose BlueCare Dental HMO network.
Enrolled in Dental PPO?
While this plan does cover out-of-network care, your benefits are greater—and cost for services is lower—when you use in-network providers. Choose BlueCare Dental PPO network.

Estimate costs—avoid surprises

Use BCBSIL’s dental cost estimator to help you find the best price. Please register or login today to Blue Access for Members to access all online resources.

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BCBSIL

ALEX

You pay less when you use network dentists. It’s the only way to get coverage in the Dental HMO, and it’s a better deal to use network dentists in the Dental PPO.

Before choosing a plan, know whether a network dentist is available in your area.