Plan Information

Features

Dental Blue offers affordable PPO solutions to meet your dental needs – all designed to give you the power to choose. Whether you choose the Dental Blue Basic or Dental Blue Enhanced, you have the power to visit any dentist or specialist in the Dental Blue Network.

Dental Blue Basic

*Even though some services are not covered as part of the dental plan, discounted fees for these services are available from in-network dentists.

Anthem Blue Cross Life and Health Insurance Company is an independent licensee of the Blue Cross Association. ®ANTHEM is a registered trademark. ®The Blue Cross name and symbol are registered marks of the Blue Cross Association.

  In-network Out-of-network
Annual Deductible $25 per member
Waived for Diagnostic and Preventive Yes No
Annual Maximum $500
Diagnostic and Preventive Services
Cleanings, exams and X-rays 100% 80%
Basic Services
Fillings 80% 60%
Other Minor Restorative Not covered
Major Services
Oral Surgery Not covered
Endodontics 50% - coverage for pulpotomies on primary teeth only
Periodontics Not covered
Prosthodontics 50% - coverage for stainless steel crowns on primary teeth only
Orthodontics Not covered
Waiting Periods No waiting period for cleanings, exams and x-rays; six-month waiting period for all other covered services