Personal Dental Coverage
Take care of your smile with Personal Dental Coverage. Studies show that many medical conditions can be avoided with regular dental care. Invest in Personal Dental Coverage or add coverage to any individual plan, at any time.
Annual Deductible
The calendar year deductible is $50 per person or a combined $150 per family. However, there is no deductible for preventive or diagnostic (such as cleanings) services covered under the plan.
As soon as the annual deductible is met, your Personal Dental Coverage will provide benefits up to our Maximum Allowable Charge for services specified in your Schedule of Benefits (up to a $1,000 annual maximum).
You can enjoy the freedom of seeing any dentist you choose, however you may find greater savings by going to a dentist in the DentalBlue network.
For example: Your dentist charges $60 for an Adult Cleaning (Prophylaxis).
| Network Dentist | Non-Network Dentist | ||||
| Dentist Charges | $60 | Dentist Charges | $60 | ||
| Network Allowance | $48 | Network Allowance | $48 | ||
| Plan Pays | -$48 | (Maximum Allowable Charge) | Plan Pays | -$48 | (Maximum Allowable Charge) |
| Provider write-off (i.e. your savings) | $12 | ||||
| You Pay | $0 | You Pay | $12 | ||
Plan Benefits
- Diagnostic and preventive services
- Restorative services
- Major restorative services including crowns, inlays and onlays *
- Endodontic services
- Periodontic services *
- Removable and fixed prosthetics *
- Oral surgical services
* 12-month waiting period applies. Orthodontia services are not covered. This list is a summary of plan benefits. Complete coverage details are included in the policy.
Limitations on Services
- 2 exams and/or cleanings in a 12-month period
- X-rays: 1 complete and 1 panoramic in 36-month period; 2 bitewings in a 12-month period
- 1 fluoride treatment in a 12-month period (for children only)
Annual Maximum
Benefits paid cannot exceed a $1,000 maximum per calendar year per covered person.
What Are the Premiums?
Monthly premiums are $26.50 for each adult and $14.60 for each dependent from age 2 through age 17.
Who Is Eligible?
You must reside in Tennessee and must not have other dental coverage of any kind. Dependent children and foreign citizens legally residing in Tennessee are also eligible. Certain restrictions apply.
How To Apply
If you are applying for Personal Health Coverage at the same time, simply check dental option box on the Personal Health Coverage application and you will be applying for Personal Dental Coverage for yourself and any dependents.
To purchase a stand-alone Personal Dental Coverage policy, just complete and return the dental application.
When Will Your Personal Dental Coverage Begin?
If you elect to purchase Personal Dental Coverage at initial enrollment in a Personal Health Coverage plan, your dental policy will be effective on the same day as your health policy. If you add Personal Dental Coverage after your medical effective date, your dental coverage will be effective the first day of the month after your change application has been received by BlueCross BlueShield of Tennessee.
When purchasing a stand-alone Personal Dental Coverage policy, it becomes effective the first day of the month after your dental application is received by BlueCross BlueShield of Tennessee.
Can You Terminate Your Personal Dental Coverage?
You can drop Personal Dental Coverage at any time.
