Page 7 - NickCo Mgmt Benefits Flipbook

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 Name Anthem Dental Complete Non-Network
Dental Benefits
Calendar Year Maximum $1,500 $1,500

Deductible (Annual)
- Individual $50 $50
- Family $150 $150
Preventive No Charge No Charge (UCR)
Exams, X-Rays, Cleanings

Basic Services Deductible, 20% Deductible, 20% (UCR)
Fillings, Oral Surgery, Endodontics, Periodontics
Major Services Deductible, 50% Deductible, 50% (UCR)
Crowns, Dentures, and Bridges
Orthodontia
- Covered Members Children Only
- Coinsurance 50%
- Lifetime Benefit Maximum $1,000

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.
If you choose to see a dentist outside of the network, you’ll be reimbursed based on Usual and Customary (UCR) charges at
the 80th percentile. You would be responsible for any amounts over the UCR as well as any coinsurance.

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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