Page 8 - 2017 MegaPath Benefits Guide_FINALV2

BENEFITS

Dental Insurance

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
Plan Name PPO Plan
Network Network* Non-Network**
Dental Benefits

Calendar Year Maximum $1,500
Deductible (Annual)
- Individual $50
- Family $150
Preventive No Charge No Charge (up to R&C limit)
Exams, X-Rays, Cleanings (Deductible Waived) (Deductible Waived)
Basic Services 80% covered after deductible 80% (R&C) covered after deductible
Fillings, Oral Surgery, Endodontics, Periodontics

Major Services 50% covered after deductible 50% (R&C) covered after deductible
Crowns, Prosthetics, Dentures, Implants
Orthodontia (Children & Adults) 50% with $1,500 Lifetime Maximum

* PDP Fees: Fees that participating dentists have agreed to accept as payment in full, subject to any copays, deductibles, cost
sharing and benefits maximums.
**R&C Fees: Reasonable and Customary charge which is based on the lowest of (1) the dentist’s actual charge, (2) the dentist’s
usual charge for the same or similar services (3) the charge of most dentists 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.
Routine dental visits not only preserve your smile, but they can provide an opportunity for the early detection of serious
diseases such as diabetes.

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