Get access to your member portal. The Medicare+Choice delivery option that includes health maintenance organizations, or HMOs (with or without a point-of-service component), preferred provider organizations (PPOs) and provider-sponsored organizations (PSOs). Dental Options Dental coverage can be purchased as an option to your plan: Both the Essential and Enhanced options provide a sliding scale for reimbursement. %PDF-1.4 % Also known as a medical-necessity review. 0000001876 00000 n General medical care that is provided directly to a patient without referral from another physician. 0000115092 00000 n Calling BlueCard Eligibility will facilitate efficient payment for the provider. You pay50% after deductible before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. BlueCare Dental Connections SM Research shows there may be a link between oral health and illnesses like heart disease, stroke, diabetes and premature birth. Limited to once every 24 months for primary teeth, and once every 48 months for permanent teeth. But you'll pay less if you see a Tier 1 PPOin-network dentist. 0000076637 00000 n 0000047131 00000 n . For more information on specific coverage you can contact customer service. There is a deductible for Class II and III services only. This new site may be offered by a vendor or an independent third party. These services are covered 12 months after you first join a Blue Dental plan. It is focused on preventive care and the treatment of routine injuries and illnesses. Pursuant to Section 1557 Blue Cross Blue Shield FEP Dental does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, age, disability, or sex (including pregnancy and gender identity). 0000050040 00000 n 0000022849 00000 n All Rights Reserved. 0000069625 00000 n 0000046543 00000 n When you partner with Blue Cross Blue Shield of Michigan, you're selecting the strongest network of providers in Michigan. See also precertification. Get access to your online account.Register Now, Not registered? Space maintainers are covered once per quadrant every two years for members to the end of the month of their 15th birthday. Covered once per tooth per lifetime. Access theDental Wellness Center. Although you can go to any dentist of your choice, your benefits under BlueCare Dental PPO Rider will be greater when you use the services of an in-network dentist. 0000003118 00000 n 0000055326 00000 n 0000107951 00000 n In group health insurance, generally a condition for which an individual received medical care during the three months immediately prior to the effective date of coverage. Root canals 0000006502 00000 n 0000075858 00000 n A review program that evaluates whether drugs are being used safely, effectively and appropriately. The BlueCare Dental PPO product is a product available for purchase on a self-funded basis only. Auxiliary or supplemental services, such as diagnostic services, home health services, physical therapy and occupational therapy, used to support diagnosis and treatment of a patient's condition. Important Legal and Privacy Information |Important Information About MedicarePlans| Privacy Practices | Site Map | Feedback | Download Adobe Acrobat Reader, All-Ages Dental Certificate of Coverage (PDF), Important Information About MedicarePlans. Cleanings are covered three times a year. collect outside the U.S. BCBS FEP Dental has a larger nationwide network with nearly half a million provider access points. 2023 BlueCare Dental PPOSM (Mid-Market) Plans, Health Care Fraud Prevention and Reporting, Texas Six (6) Month State Continuation of Coverage (Post COBRA), 2023BlueCare Dental PPO (Small Group) Plans, 2022BlueCare Dental PPO (Small Group) Plans, 2023BlueCare Dental PPO (Mid-Market) Plans, 2021BlueCare Dental PPO (Mid-Market) Plans, 2021BlueCare Dental PPO (Mid-Market) Plans - Spanish, They will receive the higher level of benefits (In-Network Benefits), They are not required to file claim forms Network providers bill Blue Cross and Blue Shield of Texas (BCBSTX) for services provided. Use our Premium Finder to easily find your premium amount or take a look at the tables below to determine your premiums. For personal medical guidance, please consult your dentist and/or physician. If you have further questions, call Customer Service at 1-855-504-2583 in the U.S. or 1-651-994-2583 A cost containment program that recovers money for healthcare where primary responsibility does not exist because of another group health plan or contractual exclusions. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. 0000011650 00000 n BlueCare Dental Choice PPO - This is known as an active plan design. Your employer should be able to provide a benefit booklet for you which will provide some details of your coverage. Carries an ID card with this identifier on it. Register Now, Not registered? One option is Adobe Reader which has a built-in reader. Use our Find a Provider tool to 0000016797 00000 n After a 12-month waiting period, cover is extended to major procedures including dentures, implants, crowns and orthodontics - all subject to an annual maximum of $1,500. The process of obtaining all the information necessary to determine the appropriate amount to pay on a given claim. Select "Log In To My Account" from the large center banner BlueCare Dental ConnectionSM is a program benefit that provides members with education and intervention through support tools and educational mailings. 00421 Free aids and services for people with disabilities to communicate effectively with us, such as: Written information in other formats (such as accessible electronic formats). 0000005826 00000 n 0000041603 00000 n If the member elects to receive care from BlueCare Dental network providers: If the member elects to receive care from providers outside of the network, they may choose: In addition, members have access to the BlueCare Dental ConnectionSMprogram. The evaluation of health questionnaires submitted by all proposed plan members to determine the overall insurability of the group. 4 HTF>QP13V2Y!QLS=k *Bl~DF*iU&!Tg))a,py7!-p{&1 !$=^S2`;bFp: v}-+OJ9bx0%M{ih,,D-O4oF$>N-fbh gj]N^|w&r~XF#81e{Ta33=gKI. 0000006259 00000 n The deductible is usually a set amount or percentage determined by the members contract and is set for a given period of time. The program integrates dental care management and health care management with a focus on preventive care and individual involvement. Oral surgery 0000005214 00000 n 0000009905 00000 n 0000029289 00000 n Our BlueCare DentalSM program offers two network-based dental products. The Patient Protection and Affordable Care Act (commonly called the ACA) was signed into law in 2010 to address access, quality and cost in the healthcare industry. Dental PPO plans are available to both insured and administrative services only (ASO) accounts. 2900 Ames Crossing Road ; Eagan, MN 55121 1-800-693-6703 . Learn more about dental services for adult STAR members, 8 a.m. to 5 p.m. Central Time Monday through Friday. 0000002793 00000 n The direct care provider should file claims to the local Blue Cross Blue Shield company. +3. June 17, 2022 . This is the limit on what your plan pays for dental care benefits for members who are 19 or older when their plan starts. 100% coverage for periodontal cleanings to members with specific health issues at no additional cost. endstream endobj 68 0 obj <> endobj 69 0 obj <> endobj 70 0 obj <> endobj 71 0 obj <> endobj 72 0 obj <> endobj 73 0 obj <>stream 15 0 obj <> endobj xref 0000007922 00000 n Understanding your Blue Cross Blue Shield FEP Dental coverage is the key to making the most of your benefits, keeping your smile healthy and protecting your overall health. 0000097745 00000 n Temporomandibular Joint Disorder (also known as TMJ, TMD, or TMJD) is also a disease that medical insurance carriers still question. 0000107816 00000 n United States Postal Service (USPS) Reform Act Allows members to use pre-tax dollars for certain eligible medical and dependent care expenses. A diagnostic and treatment process that a clinician should follow for a certain type of patient, illness or clinical circumstance. Call your child's Medicaid dental plan to learn more about the dental services they offer. Refers to any Blue Cross and/or Blue Shield Plan. This new site may be offered by a vendor or an independent third party. Individual medical expense insurance policies sold by state-licensed private insurance companies. Leading the way in health insurance since 1929. This drug list is updated monthly. Once you have identified your rating area, you can view premium amounts for our available plans in the BlueCard applies if the provider of service is outside the member's Blue Cross Blue Shield Plan's service area and does not contract with the member's Plan. The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. 0000024004 00000 n The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. The Dental Schedule of Coverage specifies benefits for: Comprehensive Dental Benefits Acrobat Distiller 11.0 (Windows) You pay50%after deductible before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. Healthcare services that are generally considered outside standard medical-surgical services because of the specialized knowledge required for service delivery and management. The PPO dental plan provides a higher level of benefits when members receive treatment from BlueCare Dental participating providers. 0000055048 00000 n 0000002422 00000 n Overview Adult Dental Pediatric Dental Overview About this plan locate a dentist in the BCBS FEP Dental network or call us at 1-855-504-2583 for assistance. BlueCare Dental Connectionis a program benefit that provides members with education and intervention through support tools and educational mailings. We have several tools and resources available to help you make informed decisions about your plan and make the most of your BCBS FEP Dental coverage. Thats why Blue Cross and Blue Shield of Texas created BlueCare Dental Connection. All Rights Reserved. Have us call you by filling outthis online form. Although the size limit of each MCO (managed care organization) may vary, a small group generally refers to a group containing at least two and less than a hundred members for which health coverage is provided by the group sponsor. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. During this unprecedented time, we're taking action to support our members. Members choose in-network care or out-of-network care at the time they make their dental appointment and usually incur higher out-of-pocket costs for out-of-network care. Not registered? Also known as prior authorization. %?Mf_A_a_A_a_A_a_A_e_E_YpV:+ Your coinsurance is your share of the costs of a service. BlueCare Dental Connection integrates dental care management and health care management with a focus on preventive care and individual involvement. Register Now, Not registered? Ottawa. BlueCare Dental HMOSM Voluntary Plan is a PPO that requires no employer contribution while still offering the employees the benefit of dental coverage in one of the largest dental PPO networks. Register Now, Not registered? HealthEquity is our business associate and is an independent company that provides account-based plan services to Blue Cross. 0000005327 00000 n /E!{"I+e1m5 Ni!V4H b~G}.5]W=7)Rxk[L9S7)cb?4 01=G35`{uio)}li.\ Ne:~Mo)ccpsYSG#xE^-x9L)qEK,duLGJNek. 0000010126 00000 n Treatment that is provided to a patient who is able to return home after care without an overnight stay in a hospital or other inpatient facility. HealthEquity has . Defining TMJ for insurance purposes TMJ has a broad definition. 0000011502 00000 n 0000005663 00000 n It is often proven by eliminating other diseases and possibilities. Visits are covered twice a year. contact your local Blue Cross Blue Shield company. There is no waiting period for Class I services. 0000088308 00000 n A federal law that outlines the requirements that employer-sponsored group insurance plans, insurance companies and managed care organizations must satisfy in order to provide health insurance coverage to individuals and groups. 0000015127 00000 n A coding inconsistency that involves separating a procedure into parts and charging for each part rather than using a single code for the entire procedure. ;m* Up to $800 of the $1,200 in-network total can be used toward out-of-network care. Need help understanding and choosing a benefit plan? Complete dentures covered once per arch every 84 months; partial dentures and bridges covered once per arch every 84 months for members age 16 and older. If a member . A medical care center that provides a wide range of healthcare services, including preventive care, acute care, surgery and outpatient care, in a centralized facility. Preventive care like exams and cleanings. Standard Option members already receive this benefit. 0000041910 00000 n A plan under which an employer's group health plan, disability plan and workers' compensation program are merged, integrated or coordinated (depending on state regulations) into a single health benefit plan that covers employees 24 hours a day. Visit www.bcbsmt.com/member 2. 0000076164 00000 n We provide health insurance in Michigan. 0000074942 00000 n 0000045351 00000 n 211 Canada. A toll-free number, 1-800-676-BLUE, for healthcare providers to verify Blue Cross Blue Shield membership and coverage information for patients. BlueCard Enables members to receive healthcare services wherever they live or travel, nationally or internationally. - Coverage for children up to the end of the month in which the member turns 19. . Additionally, members may have to submit claims for reimbursement. 0000139544 00000 n The Voluntary Plan is available for groups of 151+ employees. The designation is based on evidence-based, objective selection criteria established with input from expert physicians and recommendations from medical organizations . Federal Programs. 0000005163 00000 n Access educational information on a wide range of dental topics including pediatric care, prevention and dental treatments. Cleanings are covered twice a year. The provider of service is the one who files a claim for a service supplied to the member. Most PDF readers are a free download. The content on the Dental Wellness Center website is provided by go2dental.com . 0000010274 00000 n 0000006103 00000 n A process in which a healthcare organization undergoes an evaluation of its operating procedures to determine whether the procedures meet designated criteria as defined by the accrediting body, and to ensure that the organization meets a specified level of quality. Dental PPO can be purchased as a stand-alone dental product or in conjunction with dental HMO. A contract provision, included in all standard provider contracts, that allows either the MCO (managed care organization) or the provider to terminate the contract when the other party does not live up to its contractual obligations. If you are a BCBSIL member and have questions about your health care plan benefits, check with your group benefits administrator or contact Customer Service at the number listed on your BCBSIL member ID card. A value-added discount program that provides Blue Cross and Blue Shield members with discounts and content on health and wellness, family care, financial services and healthy travel . Adults in the BCBSTX STAR plan are not covered on the above dental plans. 0000036033 00000 n H\n0E BCBSIL assumes no liability or responsibility for damage or injury to persons or property arising from the use of any product, information, idea, or instruction contained on the Dental Wellness Center Web site; go2dental.com is solely responsible for the content and any advice given on its website. This includes all oral surgery except simple extractions, which are covered in Class II. Teeth cleaning (prophylaxis) BCBS FEP Dental is here to help you learn more about your oral health. To access your member services, please visit your BCBS company. With BlueCare Dental PPO 1A, you'll get: One of the highest maximum annual benefit levels available - up to $1,500 per person per year Orthodontic services covered up to age 19 No annual maximum on BlueCare Dental 4 Kids 1A Complete your health care coverage with a dental plan from Blue Cross and Blue Shield of . Information that relates to an individual's past, present, or future physical or mental health or condition, or the past, present, or future payment for the provision of health care to an individual, including demographic information, received from or on behalf of a health care provider, health plan, clearinghouse, or employer, which either identifies the individual or could be reasonably used to identify the individual. Limited to once every 24 months for primary teeth, and once every 48 months for permanent teeth. Contact Pacific Blue Cross for more information or to speak with one of our Service Representatives: Individual Plans Sales and Support Telephone: 604 419 2000 Fax: 604 419 2199 Email: inhealth@pac.bluecross.ca Toll-free Outside the Greater Vancouver Area: Select Blue Cross Blue Shield Global or GeoBlue if you have international coverage and need to find care outside the United States. 0000045512 00000 n 0000015051 00000 n Fluoride treatments Your child's Medicaid dental plan provides dental services including services that help prevent tooth decay and services that fix dental problems. This list is for small group or individual health plans that began on or after Jan. 1, 2014 and meet the requirements of the Patient Protection and Affordable Care Act. 0000013821 00000 n IV. In the context of a pharmacy benefit management (PBM) plan, a program that requires physicians to obtain certification of medical necessity prior to drug dispensing. Coverage for treatments varies depending on the member's benefit plan. 0000001675 00000 n 0000017747 00000 n Periodontal maintenance 3 PPOs are still the most common type of employer-sponsored health plan. Fillings The provision of mental health and chemical dependency (or substance abuse) services. A benefit payment system in which an insurer reimburses the group member or pays the provider directly for each covered medical expense after the expense has been incurred. 0000017596 00000 n Members can find information aboutagent commissions. =%V|'55KkW|_N&W4to;6ydLHO9;, mZ7mqDe"^=M'K#qFNHMDVx,>:'e ;>7o)rl-aX9]*E@l;Pz{XnGAc[=l V p\Z#'3WIHm"qq&.Sw76c\}oSm+qrA[Eg>95?Zqe"2//bZ^2OT FI"bT$.q+ Rz?>tFZm^-S~t;.3&lL5fFf$=u|A8P3*XK2Ex`Kd5.-Wy?N/e>622H#/r=$Ct^;lcEK v-wsmRT3X"/\{ D endstream endobj 74 0 obj <> endobj 75 0 obj <> endobj 76 0 obj <>stream BlueCard Access assists members who need a referral to a physician or healthcare facility in another location. We calculate our dental premiums based on your location (rating areas) and the plan option you select. Check out our Member Education Materials to get more information aboutBlue Cross You are about to leave Blue Cross and Blue Shield of Alabama's website and enter a website operated by HealthEquity. Members receive a higher level of benefits when they use in-network providers than if they use out-of-network providers. Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2022- 12/31/2022 Anthem Blue Cross: PORAC Prudent Buyer PPO Plan Coverage for: Individual + Family | Plan Type: PPO CA/L/A/CalPERS PPOC20800:PORACPrudentBuy-PPO/NA/UQBHJ/NA/01-22 1 The content on the Dental Wellness Center website is provided by go2dental.com, Inc. (go2dental.com). Also known as drug cards or prescription cards. Also known as a computer-based patient record. Site Map|Feedback|Download Adobe Acrobat Reader, Learn more about a Healthier Michigan.org, Glossary of Health Coverage and Medical Terms, Important Information About Medicare Plans. Provider Finder from Blue Cross and Blue Shield of Texas (BCBSTX) is a fast, easy-to-use tool that improves member experience when theyre looking for in-network health care providers. 0000075693 00000 n 0000059102 00000 n 0000069156 00000 n This all-ages dental plan covers 100 percent of preventive services like exams and cleanings when you see one of those in-network dentists. You are leaving this website/app (site). Established by the Balanced Budget Act, this program is designed to provide health assistance to uninsured, low-income children either through separate programs or through expanded eligibility under state Medicaid programs. In addition, some sites may require you to agree to their terms of use and privacy policy. BlueCare Dental HMO offers a dental network that is one of the largest in Illinois. Medical advisory committees also review data regarding new medical technology and examine proposed medical policies. For dental care, you can go to any licensed dentist and this plan will share the cost. 2020-09-09T21:17:19-07:00 To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. You can watchthis videoto meet your health plan advisors. 0000005030 00000 n 0000000016 00000 n trailer <<52597CAB61384F8F8DEED1C6F907D3A3>]/Prev 159881>> startxref 0 %%EOF 63 0 obj <>stream Adult BCBSTX STAR members aged 21 and older are eligible to receive dental services as a Value-Added Services. 0000139675 00000 n The MCO (managed care organization) committee that evaluates proposed policies and action plans related to clinical practice management, including changes in provider contracts, compensation and changes in authorization procedures. The fee determined by an MCO (managed care organization) to be acceptable for a procedure or service, which the physician agrees to accept as payment in full. 0000107561 00000 n A computerized record of a patient's clinical, demographic and administrative data. Preventive care like exams and cleanings. 0000001276 00000 n BlueCare Dental Connection integrates dental care management and health care management with a focus on preventive care and individual involvement. <<73BE20F0500195428ED66B90D75311C9>]/Prev 113554>> Accounts that employers can establish for employees to reimburse a portion of their eligible family members' out-of-pocket medical expenses, such as deductibles, coinsurance and pharmacy expenses. In addition, some sites may require you to agree to their terms of use and privacy policy. A summary of benefits and coverage explains things like what a health insurance plan covers, what it doesn't cover, and what your share of costs will be. Allowed amount The contracted rate, or "Blue Cross discount," set by your plan and providers when you see in-network hospital, clinics or pharmacies . Patients and members can also call Yavapai Regional Medical Center at 702-616-5789 for assistance or questions. A health maintenance organization (HMO) that contracts with a group of physicians with multiple specialties who are employees of the group practice. Children can get pediatric benefits until the end of the calendar year in which they turn 19. PPO. To view this file, you may need to install a PDF reader program. Plan Type: PDENT BlueCare Dental Connection Take Advantage of Dental and Discount Programs As a valued member, you have access to a variety of tools and resources to help you and your loved ones manage your oral health and save money through our discount programs. A listing of drugs, classified by therapeutic category or disease class, that are considered preferred therapy for a given managed population and that are to be used by an MCO's (managed care organization) providers in prescribing medications. 0000075153 00000 n Features: Review member coverage Submit claims View claims history View your membership card 0000139581 00000 n The plan features comprehensive and flexible options for coverage across three levelsGold, Silver, and Bronzeas well as some exciting new benefits that promote health equity in our province. 0000069257 00000 n Traditional insurance, also known as Indemnity or Fee-for-Service, allows members to select any healthcare provider for services. How can bcbstx Star members get help with dental services? Anthem's medical plans offer healthcare coverage you and your family can rely on. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. Refer to this list for drug coverage information for Blue Cross members whose plan uses the Custom Select Drug List. Log in and look. Free language assistance to people whose primary language is not English, such as: Calling Blue Cross Blue Shield FEP Dental at 1-855-504-BLUE (2583), dial 711 for TTY relay services. We provide health insurance in Michigan. a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Call us at 800-531-4456 or contact an independent, authorized Blue Cross and Blue Shield of Texas agent. The process of identifying and classifying the risk represented by an individual or group. Addresses the health and lifestyle needs of consumers through unique partnerships and experiences designed exclusively for Blue365 members. It identifies the member's Blue Cross Blue Shield company or national account in order to properly route the claim. What are the side effects of Thiazolidnedions. The health plan physician executive who is responsible for the quality and cost-effectiveness of the medical care delivered by the plan's providers. Bridges and dentures Search for Doctors, Hospitals and Dentists Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. If you have a significant life event, you may still be able to get 2023 coverage through special enrollment. For all of your dental questions and/or claim forms, please contact your local Blue Cross Blue Shield company. 0000045487 00000 n Bitewing X-rays We will cover all overseas services at the in-network level for all members. 4VOCevR%M"|~GHI84SRhX/ p ?P\H19y+_Q /iY.Q6?/??h= $Ng3,M;Tz\LJhzs"N@?XGGy*& b BHI brings together the healthcare experience of more than 54 million Blue Cross and Blue Shield members nationwide. 0000088585 00000 n Your deductible is the amount you pay for dental services each year before your insurance begins to pay. The Pacific Blue Cross Mobile app helps you manage your benefits and improve the health & wellbeing of you and your family. PDENT is your dental plan. Limited to three times a year in combination with routine cleaning. application/pdf Both products have multiple plan options. For travellers, the app is the fastest way to buy and manage Canada's most trusted brand in travel insurance.

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