Page 11 - California Eye Management EE Guide 2019

Dental Benefits

Anthem Blue Cross | HMO Dental Plan
With the Anthem Blue Cross dental HMO plan, you'll have access to an extensive network of dental providers without paying
deductibles or filling out claim forms. Plus, it's easy. First, choose a dental provider from our network during enrollment.
Then, contact this dental provider for all of your dental care, including referrals for consultation with plan specialists and
emergency services. If you have questions or want to switch providers, call Customer Service.

Anthem Blue Cross | PPO Dental Plan
With the Anthem Blue Cross Preferred Provider Organization (PPO) dental plan, you may visit a PPO dentist and benefit from
the negotiated rate or visit a non‐network dentist. When you utilize a PPO dentist, your out-of-pocket expenses will be less.
You may also obtain services using a non-network dentist; however, you will be responsible for the difference between the
covered amount and the actual charges and you may be responsible for filing claims.

Anthem Blue Cross Anthem Blue Cross
Plan Name DHMO Plan DPPO Plan

Network Network Network Non-Network
Dental Benefits
Calendar Year Maximum N/A $1,500 $1,500
Deductible (Annual)
- Individual N/A $50 $50
- Family N/A $150 $150
Preventive (Plan Pays) 100% 100% 100%
Exams, X-Rays, Cleanings

Basic Services (Plan Pays) Deductible, 80% Deductible, 80%
Fillings, Oral Surgery, Endodontics, Perio- Refer to Dental Net®
dontics Dental HMO Plan
Major Services (Plan Pays) 2000A Summary Deductible, 50% Deductible, 50%
Crowns, Prosthetics

Orthodontia (Children/Adult) $1,695 / $1,895 Not covered

Finding In-Network Dental Providers
Go to www.anthem.com/ca or call (877) 567-1804. Refer to the “Dental Complete” network when prompted.

Dental Tips:

The least expensive way to maintain good oral health is to go to your dentist at least twice each year for an exam and cleaning.
Regular dentist visits can help prevent serious health problems such as oral diseases and cancers, and going to the dentist is
more affordable in the long run for those who are insured and take advantage of every service.

We strongly recommend you ask your dentist for a predetermination if total charges are expected to exceed $300.
Predetermination enables you and your dentist to know in advance what the payment will be for any service that may be in
question.

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