An individual or organization that offers care directly to the member. The Patient Protection and Affordable Care Act (commonly called the ACA) was signed into law in 2010 to address access, quality and cost in the healthcare industry. 0000072854 00000 n Is your health coverage changing. A health maintenance organization (HMO) that contracts with multiple group practices of physicians or specialty groups. State and Federal Privacy laws prohibit unauthorized access to Member's private information. PDENT is your dental plan. . Sinema Applauds Dignity Health and Blue Cross Blue Shield for Reaching The integration of financing and delivery of healthcare within a system that seeks to manage the accessibility, cost and quality of that care. 0000005867 00000 n When you partner with Blue Cross Blue Shield of Michigan, you're selecting the strongest network of providers in Michigan. It is often proven by eliminating other diseases and possibilities. With the Premium plan preventive care is free and after 6 months the co-payment for fillings and simple extractions is just 20%. A set of four films is covered once a year. Member Discounts Take advantage of member-only discounts on health-related products and services. 0000075153 00000 n Understanding yourBlue Cross Blue ShieldFEP Dental coverage is the key to making the most of your Glossary | Blue Cross Blue Shield PPO. A plan under which an employer's group health plan, disability plan and workers' compensation program are merged, integrated or coordinated (depending on state regulations) into a single health benefit plan that covers employees 24 hours a day. Get access to your online account. A coding inconsistency that involves separating a procedure into parts and charging for each part rather than using a single code for the entire procedure. PBC pays the pharmacy 80% of your prescription cost, and you pay the pharmacist the remaining 20%. 2 0 obj <>/Metadata 7 0 R/Names 8 0 R/OpenAction 6129 0 R/Outlines 6130 0 R/PageLayout/OneColumn/PageMode/UseOutlines/Pages 838 0 R/StructTreeRoot 2595 0 R/Type/Catalog/ViewerPreferences<>>> endobj 3 0 obj <>/Font<>>>/Fields[]>> endobj 7 0 obj <>stream A contract provision that allows either the MCO (managed care organization) or the provider to terminate the contract without providing a reason or offering an appeals process. The three dental plans for children on Medicaid are: Dentaquest, MCNA Dental and UnitedHealthcare Dental. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. PDENT is your dental plan. A toll-free number, 1-800-810-BLUE, that members can use to locate providers in another Blue Cross Blue Shield company's area. An individual or organization that offers care to patients from outside the local Plan's service area. 0000003753 00000 n If you have a significant life event, you may still be able to get 2023 coverage through special enrollment. Dental exams 0000005826 00000 n Addresses the health and lifestyle needs of consumers through unique partnerships and experiences designed exclusively for Blue365 members. BlueCare Dental Connection integrates dental care management and health care management with a focus on preventive care and individual involvement. 1. 0000049726 00000 n In the United States, Puerto Rico and U.S. Virgin Islands. A utilization and quality management mechanism designed to aid providers in making decisions about the most appropriate course of treatment for a specific clinical case. Qualified contributions made to HSAs are tax-deductible, and funds withdrawn to pay for qualified medical expenses are tax-free. by: Nichole Niemann. But you'll pay less if you see a Tier 1 PPOin-network dentist. PDF 2022 BlueCare Dental ClassicSM Individual medical expense insurance policies sold by state-licensed private insurance companies. Allows members to save money into tax-advantaged accounts. The website lets members log daily activities and track progress over time. 0000115129 00000 n ;m* A method of planning and implementing quality management programs that consists of identifying the best practices and best outcomes for a specific process and emulating the best practices to equal or surpass the best outcomes. Find a planto get a quote. 0000139581 00000 n 00421 ]YAVdYAV/E 0000076164 00000 n Get access to your employer portal. Blue Cross Blue Shield awards this designation to medical facilities that have demonstrated expertise in delivering quality healthcare in the areas of: bariatric surgery, cardiac care, complex and rare cancers, spine surgery, transplants and knee and hip replacement. xref Plan Type: PDENT BlueCare Dental Connection Take Advantage of Dental and Discount Programs As a valued member, you have access to a variety of tools and resources to help you and your loved ones manage your oral health and save money through our discount programs. Use ourProvider Finderto search for doctors and pharmacies near you. Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. You start paying coinsurance after youve met your plans deductible. For more detailed information on the plan designs available, covered benefits, services and supplies that are limited or excluded, general administration of the plan, or any other questions you may have regarding our products and services, please contact your account representative for the phone number of the regional sales office near you. Your employer should be able to provide a benefit booklet for you which will provide some details of your coverage. Blue Cross and Blue Shield of Texas (BCBSTX) covers emergency dental services your child gets in a hospital or ambulatory surgical center. BCBSOK and go2dental.com are separate companies. For dental care, you can go to any licensed dentist and this plan will share the cost. X~ )T`2*>+;NC][i\3{- GWn.gr7NrYa?5*~'sfn:6hV-_b{. Individuals attempting unauthorized access will be prosecuted. There is no waiting period for pediatric dental. 0000075693 00000 n Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. 0000005214 00000 n H\j@{\lP|di A diagnostic and treatment process that a clinician should follow for a certain type of patient, illness or clinical circumstance. 0000041318 00000 n Accounts that employers can establish for employees to reimburse a portion of their eligible family members' out-of-pocket medical expenses, such as deductibles, coinsurance and pharmacy expenses. Also known as drug cards or prescription cards. HUKo@WoR",8iiz5f. 0000050349 00000 n Call Dentaquest at 1-800-516-0165,MCNA Dental at 1-800-494-6262or UnitedHealthcare Dental at 1-800-822-5353. Features: Review member coverage Submit claims View claims history View your membership card Alberta. PII does not include publicly available information that is lawfully made available to the general public from federal, state or local government records or widely distributed media. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. T9"TaS~mMeOL2Xi$HS#f8eN@PW :V 5nw_qTKRPHKj:rfYqb7u/l&9T5oku`!r[Wsv^t';/#3B^>`BlHj\vu$8JaaJt\#+h1%Dj-M*9=>G@i[f>H!3nC1*kjytKuT8dF z|/ yA'#G*'zY6#a)8FXwTs;K:q*i97O|yr,f9+:BMg/tY6x43rXN^r>9sDGLt7A3RCsJ%s m7 The provision of mental health and chemical dependency (or substance abuse) services. If you can't find what you're looking for, please visit our Contact Us page for further assistance. Fully Insured Summary of Dental Benefits 2023 BlueCare Dental PPO (Small Group) Plans 0000008069 00000 n 0000046006 00000 n Once you have identified your rating area, you can view premium amounts for our available plans in the If you're considering enrolling in one of our individual and family plans, learn a bit more about the coverage you'll receive. These services are covered six months after you first join a Blue Dental plan. We provide health insurance in Michigan. Up to $800 of the $1,200 in-network total can be used toward out-of-network care. A review program that evaluates whether drugs are being used safely, effectively and appropriately. Additionally, members may have to submit claims for reimbursement. To find your premium, locate your state and/or zip code in the rating area table below and to identify your rating area. A toll-free number, 1-800-676-BLUE, for healthcare providers to verify Blue Cross Blue Shield membership and coverage information for patients. 0000029289 00000 n Preventive care programs designed to determine if a health condition is present even if a member has not experienced symptoms of the problem. Periodontal maintenance A private medical expense insurance policy that provides reimbursement for out-of-pocket expenses, such as deductibles and coinsurance payments, or benefits for some medical expenses specifically excluded from Medicare coverage. External link You are leaving this website/app (site). Allowed amount The contracted rate, or "Blue Cross discount," set by your plan and providers when you see in-network hospital, clinics or pharmacies . The services covered include: Teeth cleanings. Bridges and dentures Adult BCBSTX STAR members aged 21 and older are eligible to receive dental services as a Value-Added Services. There are three ways to enroll in BlueCare Dental PPO: Select 'YES' next to the Dental option when you apply online for any qualifying Blue Cross and Blue Shield of Texas health plan. Standard Option members already receive this benefit. Does Blue Cross and blue shield of Texas (bcbstx) have a dental Wellness Center? 0000000016 00000 n H\n0E The process of obtaining all the information necessary to determine the appropriate amount to pay on a given claim. Most PDF readers are a free download. 0000072686 00000 n trailer 0000055326 00000 n Non-contracting dentists will charge employees their regular fee and may bill them for the balance not covered by the dental benefit plan. The broad range of activities that an MCO and its employees undertake to support the delivery of the promised benefits to members and ensure member satisfaction. Basic services like fillings and root canals. For all of your dental questions and/or claim forms, please contact your local Blue Cross Blue Shield company. Adult members are age 19 or older at the start of the coverage year. It includes such information contained in any form or medium (electronic, paper, oral, etc.). Documentation errors in which a treatment is miscoded or the codes used to describe procedures do not match those used to identify the diagnosis. Calling BlueCard Eligibility will facilitate efficient payment for the provider. Blue Cross Blue Shield companies provide a best-in-class, comprehensive suite of international products and services for people who live, work and travel internationally, giving them confidence that quality care can be accessed wherever and whenever they need it. 0000088585 00000 n Learn more about BCBS FEP Dental plan benefits and premiums. : ]O,l22/JX.bx.`=+cJ|?% r9J2InHV`@Lb`\a%diF`3200h f`ig`` a hb```e`` l@Q>l e I#r^ Space maintainers Our AskBlue. Box 986030, Boston, MA 02298. Need help understanding and choosing a benefit plan? application/pdf PDF BlueCare Dental PPO - BCBSIL Teeth cleaning (prophylaxis) 0000004814 00000 n For all of your dental questions and/or claim forms, please contact your local Blue Cross Blue Shield company. HUQs6~W:Yc%v9^n.R`s?x%X:i2A-}'o$n @(LkPW[BTn e"+POlkk-boX:\(%r)%|z>n!RL&i q9zy JRah#J~xB2Wz 1e9d`\d"I`:=&8',a4$ldXaC]Z-2mJutPtX1nVXc "h|e2e4"*D=I 0000002422 00000 n Introducing our new Health and Dental plan 0000014199 00000 n A provision in a member's coverage that limits the amount of coverage by the plan to a certain percentage, commonly 80 percent. 0000139544 00000 n The focus is simple: offer employers multiple dental plan designs that allow greater flexibility to choose a design that best suits their needs at a reasonable price. Sending a letter to Blue Cross Blue Shield FEP Dental, P.O. - Coverage for children up to the end of the month in which the member turns 19. . Limited to once every 24 months for primary teeth, and once every 48 months for permanent teeth. The Patient Protection and Affordable Care Act was signed into law on March 23, 2010, and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. Blue Cross and Blue Shield of Texas, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). We have several tools and resources available to help you make informed decisions about your plan and make the most of your BCBS FEP Dental coverage. An itemized statement of healthcare services and their costs provided by a hospital, physician's office or other provider facility. The three characters preceding the subscriber identification number on BCBS member ID cards. e.g., oral surgery, fillings, gum scaling, e.g., crowns, bridges, implants, root canals, dentures, Premium Standard Options Chart - Self Only, Average Cost Savings Chart - What you pay with High Option, Standard and High Option Plan Benefits and Premiums. For more information, please contact your account executive at 1-505-837-8787 or toll-free at 1-800-672-9700. Children can get pediatric benefits until the end of the calendar year in which they turn 19. The direct care provider should file claims to the local Blue Cross Blue Shield company. The site may also contain non-Medicare related information. A joint federal and state program that provides hospital expense and medical expense coverage to the low-income population and certain aged and disabled individuals. Also known as a group practice model HMO. 0000062841 00000 n uuid:63d11d8f-8f4f-474a-a014-6ba0ac5e1aeb The process of identifying and classifying the risk represented by an individual or group. To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. A Medicare supplement that uses a preferred provider organization (PPO) to supplement Medicare Part B coverage. hb``b``f`c`pjed@ AV(7{`SopLY-}Piii@ 1)ix`)b}$?G^9[+ 0 fsLRG&c{\.p6^gW||g$k%X86X H36 5 endstream endobj 16 0 obj <>>> endobj 17 0 obj >/PageUIDList<0 218>>/PageWidthList<0 612.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/Properties<>/Shading<>>>/Rotate 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 18 0 obj <>stream 0000014575 00000 n Individuals attempting unauthorized access will be prosecuted. Download a paper application and email to help@ihealthagents.com or fax to 847-220-9280. 0000006632 00000 n It also gives you the freedom to choose any dentist you want by helping to cover the cost of care when you see a dentist who isn't in our PPO network. 0000013821 00000 n Carries an ID card with this identifier on it. This includes all oral surgery except simple extractions, which are covered in Class II. 2023 BlueCare Dental PPOSM (Mid-Market) Plans, Health Care Fraud Prevention and Reporting, Texas Six (6) Month State Continuation of Coverage (Post COBRA), 2023BlueCare Dental PPO (Small Group) Plans, 2022BlueCare Dental PPO (Small Group) Plans, 2023BlueCare Dental PPO (Mid-Market) Plans, 2021BlueCare Dental PPO (Mid-Market) Plans, 2021BlueCare Dental PPO (Mid-Market) Plans - Spanish, They will receive the higher level of benefits (In-Network Benefits), They are not required to file claim forms Network providers bill Blue Cross and Blue Shield of Texas (BCBSTX) for services provided. 0000041603 00000 n PDF Outline of Coverage - Blue Cross Blue Shield of Massachusetts A toll-free number, 1-800-676-BLUE, for healthcare providers to verify Blue Cross Blue Shield membership and coverage information for patients. In Texas, Medicaid is the program that will offer the most comprehensive dental coverage, especially for children (anyone under 21). Register Now, Not registered? Log in and look. 0000074942 00000 n Although the size limit of each MCO (managed care organization) may vary, a small group generally refers to a group containing at least two and less than a hundred members for which health coverage is provided by the group sponsor. Refer to this list for drug coverage information for Blue Cross members whose plan uses the Custom Select Drug List. This program provides members with education and intervention through support tools and educational mailings. Outside the United States. Also known as disease state management. The content on the Dental Wellness Center website is provided by go2dental.com. benefits, keeping your smile healthy and protecting your overall health. 0000039957 00000 n The Dental Schedule of Coverage specifies benefits for: Comprehensive Dental Benefits H\n0. 0000001675 00000 n This list is for small group or individual health plans that began on or after Jan. 1, 2014 and meet the requirements of the Patient Protection and Affordable Care Act. PDF BlueCare DentalSM for Individuals and Families - Texas Health Agents Check out our Member Education Materials to get more information aboutBlue Cross The examples are meant to help you understand what you might pay, and compare that to other plans. The group must also offer an alternate dental option to HMO. 0000001276 00000 n BCBS FEP Dental has nearly half a million provider access points nationwide to receive in-network services, a customer service team dedicated to exceeding your expectations, online tools to make your life easier, and a variety of options and benefits to meet your needs.
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