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Dental Option:
BCBS of Oklahoma
PAY PERIOD 24 26 Dependent Information
Employee Only No Cost No Cost Our company offers employees the opportunity to
cover their dependent children. Children can join or
Employee + Spouse No Cost No Cost remain on a parent’s dental plan until age 26.
When a child turns 26, they will lose dental coverage
Employee + Child(ren) No Cost No Cost on the last day of their birth month.
Employee + Family No Cost No Cost
Type of Service (In-Network) Amount Paid
Out of Network is at (90th Percetile)
Preventive Services Covered at 100%; No Calendar Year Deductible (CYD)
Basic Services Covered at 80% After CYD
Major Services Covered at 50% after CYD
Calendar Year Deductible $50 Individual / $150 Family
Annual Maximum $1,500 per person
Waiting Periods for Major Services None
Type of Service Benefit Description
Preventive Services Oral Exams, Cleanings, X-rays, Sealants, Fluoride Treatment
Fillings, Simple Extractions, Space Maintainers, Oral Surgery,
Basic Services
General Anesthesia, Endodontics and Periodontics
Major Services Crowns, Bridges, Dentures, Inlays & Onlays and Implants.
Annual Maximum Applies January 1 to December 31
Up to $1500 Lifetime Max; Available for Adults & Children
Orthodontics
Covered at 50%
NOTE: This is only a brief overview. Please see the Benefit Summary for more details.
Website: www.bcbsok.com or Customer Service : 888-381-9727
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