Page 8 - 2017 MegaPath Benefits Guide_FINAL
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BENEFITS
Dental Insurance
Anthem Blue Cross | PPO Dental Plan
With the Anthem Blue Cross Preferred Provider Organiza on (PPO) dental plan, you may visit a PPO den st and benefit from the
nego ated rate or visit a non‐network den st. When you u lize a PPO den st, your out‐of‐pocket expenses will be less. You may
also obtain services using a non‐network den st; 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
Plan Name PPO Plan
Network Network* Non‐Network**
Dental Benefits
Calendar Year Maximum $1,500
Deduc ble (Annual)
‐ Individual $50
‐ Family $150
Preven ve No Charge No Charge (up to R&C limit)
Exams, X‐Rays, Cleanings (Deduc ble Waived) (Deduc ble Waived)
Basic Services 80% covered a er deduc ble 80% (R&C) covered a er deduc ble
Fillings, Oral Surgery, Endodon cs, Periodon cs
Major Services 50% covered a er deduc ble 50% (R&C) covered a er deduc ble
Crowns, Prosthe cs, Dentures, Implants
Orthodon a (Children & Adults) 50% with $1,500 Life me Maximum
* PDP Fees: Fees that par cipa ng den sts have agreed to accept as payment in full, subject to any copays, deduc bles, cost
sharing and benefits maximums.
**R&C Fees: Reasonable and Customary charge which is based on the lowest of (1) the den st’s actual charge, (2) the den st’s
usual charge for the same or similar services (3) the charge of most den sts in the same geographic area for the same or similar
services as determined by Anthem Blue Cross.
Finding a Dental Provider
Go to www.anthem.com/ca or call (877) 567‐1804. Refer to the “Dental Complete” network when prompted.
Tips For Using Your Dental Benefits
Use contracted network providers when possible.
Under the PPO plan, contracted network providers have rate agreements with insurance companies for services rendered. If
you use a non‐network provider, your out‐of‐pocket expenses will be higher and you may be subject to balance billing.
Ask for a predetermination of benefits.
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.
Have dental checkups regularly.
Rou ne dental visits not only preserve your smile, but they can provide an opportunity for the early detec on of serious
diseases such as diabetes.
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