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Introducing our new Health and Dental plan A listing of drugs, classified by therapeutic category or disease class, that are considered preferred therapy for a given managed population and that are to be used by an MCO's (managed care organization) providers in prescribing medications. The evaluation of health questionnaires submitted by all proposed plan members to determine the overall insurability of the group. But you'll pay less if you see a Tier 1 PPOin-network dentist. 0000015769 00000 n 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. BlueCard Enables members to receive healthcare services wherever they live or travel, nationally or internationally. 0000006097 00000 n Select "Log In To My Account" from the large center banner Qualified contributions made to HSAs are tax-deductible, and funds withdrawn to pay for qualified medical expenses are tax-free. HVKH+Djj+r%VF9dje;!h]_gLP8a "&SDi^&=.k)VU_? |7 Call your child's Medicaid dental plan to learn more about the dental services they offer. 0000045487 00000 n 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). If you have any questions or comments regarding the Dental Wellness Center website, you should direct them to go2dental.com, Blue Cross and Blue Shield of Illinois, 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). Space maintainers An evaluation of the medical necessity, appropriateness and cost-effectiveness of healthcare services and treatment plans for a given patient. Select Blue Cross Blue Shield Global or GeoBlue if you have international coverage and need to find care outside the United States. PDF Your Health Care Benefit Program 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. These documents also show your estimated costs for two sample medical events: having a baby and managing diabetes. Limited to once every 24 months for primary teeth, and once every 48 months for permanent teeth. As a member of Blue Cross Blue Shield FEP Dental, we aim to provide the highest level of service available. 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. The services covered include: Teeth cleanings. Root canals When you partner with Blue Cross Blue Shield of Michigan, you're selecting the strongest network of providers in Michigan. premium table below. It is only available under an insured funding arrangement for groups sized 51 or more lives. 0000007922 00000 n What are the side effects of Thiazolidnedions. Visit www.bcbsmt.com/member 2. locate a dentist in the BCBS FEP Dental network or call us at 1-855-504-2583 for assistance. 0000049503 00000 n BlueCare Dental is a portfolio of standard dental preferred provider option (PPO) benefit plan designs BlueCare Dental Freedom SM and BlueCare Dental Choice SM. 0000050349 00000 n H\j@{\lP|di The BlueCare Dental HMO network includes specialists such as oral surgeons, orthodontists, pediatric dentists, endodontists (specialists in diseases of the nerve within the tooth) and periodontists (specialists in diseases of the gums and tissues). BlueCare Dental HMO offers a dental network that is one of the largest in Illinois. Fillings and sealants. DentaQuest can help members find in-network providers and get authorizations for dental services. Does Blue Cross and blue shield of Texas (bcbstx) have a dental Wellness Center? A company that is owned by its members or policyowners. 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. The application of managed care principles (techniques to reduce costs and improve quality of heallthcare) to 24-hour coverage. 0000003994 00000 n takes the health and well-being of our members, providers, our associates and our business partners seriously. A flat amount the member must pay before the insurer will make any benefit payments. TTY users dial 711. UYUy>vcUbR!|ilJg 0 endstream endobj 19 0 obj <> endobj 20 0 obj <> endobj 21 0 obj <> endobj 22 0 obj <> endobj 23 0 obj [/DeviceN[/Cyan/Magenta/Black]/DeviceCMYK 53 0 R 55 0 R] endobj 24 0 obj <> endobj 25 0 obj <> endobj 26 0 obj <>stream Not registered? You pay50%after deductible before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. Box 551, Minneapolis, MN 55440-0551. HTF>QP13V2Y!QLS=k *Bl~DF*iU&!Tg))a,py7!-p{&1 !$=^S2`;bFp: v}-+OJ9bx0%M{ih,,D-O4oF$>N-fbh gj]N^|w&r~XF#81e{Ta33=gKI. Healthcare services provided to a health maintenance organization (HMO) member in exchange for a fixed, monthly premium paid in advance of the delivery of medical care. 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. A national program that offers members traveling or living outside of their Blue Cross Blue Shield Plan's area the PPO (preferred provider organization) level of benefits when they obtain services from a physician or hospital designated as a PPO provider. Blue Cross Blue Shield FEP Dental - Benefits & Premiums 0000058858 00000 n Programs designed to educate and motivate members to prevent illness and injury and to promote good health through lifestyle choices, such as smoking cessation and dietary changes. An itemized statement of healthcare services and their costs provided by a hospital, physician's office or other provider facility. Sealants are covered once per fully erupted first and second permanent molar every 36 months for members to the end of the month of their 16th birthday. You can watchthis videoto meet your health plan advisors. 0000069156 00000 n Periodontal maintenance 0000075153 00000 n Healthcare services that are generally considered outside standard medical-surgical services because of the specialized knowledge required for service delivery and management. Enables members to receive healthcare services wherever they live or travel, nationally or internationally. 0000074942 00000 n Oral health touches every aspect of our lives but is often taken for granted. 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 NOT FOR DISTRIBUTION TO BENEFICIARIES, MEMBERS, OR PROSPECTS BlueCare Dental Classic Plans 1,2 BlueCare Dental Classic plans cover only one person per policy. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred. 0000002464 00000 n To view this file, you may need to install a PDF reader program. 0000034533 00000 n Please note, this is a summary of features of Blue Cross Blue Shield FEP . The site may also contain non-Medicare related information. Teeth cleaning (prophylaxis) This out-of-pocket maximum is the most youll have to pay during a calendar year for covered pediatric dental services. 0000002793 00000 n 0000047395 00000 n What is Pdent? - Shabupc.com Blue Cross Blue Shield A group of healthcare providers that agrees to deliver coordinated care, meeting performance benchmarks for quality and affordability in order to manage the total cost of care for their member populations. BCBSOK and go2dental.com are separate companies. After reaching that limit for the year, you pay for 100% of your dental care. Dollar amounts set by MCOs (managed care organizations) that limit the amount a member has to pay out of his/her own pocket for particular healthcare services during a particular time period. PPOs have lost some of their popularity in recent years as health plans reduce the size of their provider networks and increasingly switch to EPOs and HMOs in an effort to control costs. 3. 211 is the source Canadians trust when seeking information. 0000088308 00000 n A summary of benefits and coverage explains things like what a health insurance plan covers, what it doesn't cover, and what your share of costs will be. endstream endobj 68 0 obj <> endobj 69 0 obj <> endobj 70 0 obj <> endobj 71 0 obj <> endobj 72 0 obj <> endobj 73 0 obj <>stream 0000005030 00000 n 15 49 Fluoride treatments are covered twice a year for members to the end of the month of their 19th birthday. 0000006632 00000 n 0000004772 00000 n Important Legal and Privacy Information|Important Information About Medicare Plans|Privacy Practices There is no waiting period for pediatric dental. These cards assist PBMs in processing and tracking pharmaceutical claims. 0000003587 00000 n 1-800-267-8221. 2. 1996-2022 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. 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. Fillings A set of specialized healthcare services that provide support to terminally ill patients and their families. For personal medical guidance, please consult your dentist and/or physician. A contract provision, included in all standard provider contracts, that allows either the MCO (managed care organization) or the provider to terminate the contract when the other party does not live up to its contractual obligations. 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. A cost containment program that recovers money for healthcare where primary responsibility does not exist because of another group health plan or contractual exclusions. 0000075693 00000 n Contact Pacific Blue Cross for more information or to speak with one of our Service Representatives: Individual Plans Sales and Support Telephone: 604 419 2000 Fax: 604 419 2199 Email: inhealth@pac.bluecross.ca Toll-free Outside the Greater Vancouver Area: Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. Is your health coverage changing. Get access to your online account. A document that provides background information about various underwriting impairments and suggests the appropriate action to take if such impairments exist. Teeth cleaning (prophylaxis) 0000041910 00000 n Below are answers to some of the frequently asked questions. The content on the Dental Wellness Center website is provided by go2dental.com, Inc. (go2dental.com). 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. T9"TaS~mMeOL2Xi$HS#f8eN@PW :V 5nw_qTKRPHKj:rfYqb7u/l&9T5oku`!r[Wsv^t';/#3B^>`BlHj\vu$8JaaJt\#+h1%Dj-M*9=>G@i[f>H!3nC1*kjytKuT8dF z|/ yA'#G*'zY6#a)8FXwTs;K:q*i97O|yr,f9+:BMg/tY6x43rXN^r>9sDGLt7A3RCsJ%s m7 0000139581 00000 n Allowed amount The contracted rate, or "Blue Cross discount," set by your plan and providers when you see in-network hospital, clinics or pharmacies . IyaPC96>$i}KFVLWEs$g;iQrij:J]#b]Fd`0c;TU\5ZXyZbb{l I6Be6i^f+viqy .px8~N endstream endobj 66 0 obj <> endobj 67 0 obj <>stream Please refer to your Dental Benefit Booklet for additional benefit information. The review and possible authorization of proposed treatment plans for a patient before the treatment is implemented. 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. Register Now, Not registered? Call: 833-901-1364 Learn more. A coordinated system of preventive, diagnostic and therapeutic measures intended to provide cost-effective, quality healthcare for a patient population who have or are at risk for a specific chronic illness or medical condition. If you can't find what you're looking for, please visit our Contact Us page for further assistance. 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 Dental exams Cleanings are covered twice a year. Blue Cross Blue Shield FEP Dental complies with all applicable Federal civil rights laws, to include both Title VII and Section 1557 of the ACA. It includes such information contained in any form or medium (electronic, paper, oral, etc.). 0000017747 00000 n PDF REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form t@^@#"Z|2]>q/CS"f 24Dg:y2 United States Postal Service (USPS) Reform Act BlueCare Dental Choice PPO - This is known as an active plan design. Members fund their FSAs with contributions that come out of their paycheck. 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. 0000006747 00000 n Glossary | Blue Cross Blue Shield 0000017596 00000 n Dental Benefits | Blue Cross and Blue Shield of Illinois - BCBSIL p ?P\H19y+_Q /iY.Q6?/??h= $Ng3,M;Tz\LJhzs"N@?XGGy*& b Register Now, Not registered? PScript5.dll Version 5.2.2 You are about to leave Blue Cross and Blue Shield of Alabama's website and enter a website operated by HealthEquity. 0000063121 00000 n 0000004667 00000 n Space maintainers are covered once per quadrant every two years for members to the end of the month of their 15th birthday. Refers to any Blue Cross and/or Blue Shield Plan. Maximum dollar amounts set by MCOs (managed care organizations) that limit the total amount the plan must pay for all healthcare services provided to a subscriber per year or in his/her lifetime.
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