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costs if you choose a dentist who participates in the Anthem Blue Cross network. When you utilize a network dentist, your out-of-pocket expenses will be less,
however, you will usually pay the lowest amount for services when you visit a PPO dentist. If you obtain services using a non-network dentist, you will be
Our dental plans offer you the freedom and flexibility to use the dentist of your choice. However, you will maximize your benefits and reduce your out-of-pocket
We strongly recommend you ask your dentist for a predetermination if total charges are expected to Predetermination enables you and your dentist to know in advance what the payment will be for any service that may be in
responsible for the difference between the covered amount and the actual charges and you may be responsible for filing claims. The chart below provides a high-

Note: exceed $300. question.

DENTAL PLAN CHOICES
Option 2 Anthem Blue Cross PPO Low Non-Network Dental Complete $1,000 $1,000 $150 $100 $450 $300 No Charge* No Charge Deductible, 50%* Deductible, 30% Deductible, 50%* Deductible, 50% Not Covered Not Covered Go to www.anthem.com/ca or call (877) 567-1804. Refer to the Anthem Dental Complete network when prompted.

Finding a Dental Provider

Option 1 Anthem Blue Cross PPO High Non-Network Dental Complete $1,500 $1,500 $100 $50 $300 $150 No Charge* No Charge Deductible, 20%* Deductible, 10% Deductible, 50%* Deductible, 35% 50% / $1,500 Lifetime Benefit Maximum 50% / $1,500 Lifetime Benefit Maximum

Anthem Blue Cross | PPO Plans
what Anthem pays them and what the dentist usually
level overview of your dental plan. Network Name Dental Benefits Calendar Year Maximum Benefit Annual Deductible Preventive Services *Dentists who are out-of-network have not agreed to pricing, and may bill you for the difference between EMPLOYEE BENEFITS

Major Services
Basic Services
Plan Name
Orthodontia
- Individual
- Family
charges.
- Adult
- Child
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