Optional Coverage

Optional Coverage – Dental

BlueCross BlueShield of Tennessee also offers Personal Dental Coverage. Enjoy low monthly premiums – just $26.50 for each adult and $14.60 for dependents from ages 2 through 17.

Plan Features

• Gain access to the largest dental PPO network in the state.
• Choose any dentist you like, but save more by using a network dentist.
• Keep in your budget with a low $50 calendar year deductible per person or $150 per family.
• Enjoy an annual maximum of $1,000 per person once your deductible has been met.
• Because BlueCross pays for services based on what's called a Maximum Allowable Charge (or MAC) fee schedule, your money is stretched even further.

Covered Dental Services

• Diagnostic and preventive services
• Restorative services
• Major restorative services like crowns and onlays*
• Endodontic services
• Periodontic services*
• Removable and fixed prosthetics*
• Oral surgical services

*A 12-month waiting period applies to these services. Orthodontia services are not covered.

Limitations on Dental Services

• Your coverage includes two exams in a 12-month period.
• Your coverage includes two cleanings in a 12-month period.
• You may have one complete and one panoramic X-ray in a 36-month period. Your coverage also includes two bitewings (X-rays) in a 12-month period.
• Children may have one fluoride treatment in a 12-month period.

Exclusions on Dental Services

• Cosmetic procedures
• Dental implants
• Orthodontic services
• Mouth guards
• Prescription drugs
• Any service not listed in the schedule of benefits under Attachment C of the policy
• Any portion of the charge that exceeds the Maximum Allowable Charge (MAC)

This is only a partial list. A complete list of coverage details, limitations and exclusions is included in the policy and can be requested from your agent or BlueCross sales representative.

Below is an example showing how much you may pay for a routine cleaning.