Blue
Shield Dental PPO & HMO Plans - California |
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Blue
Shield offers affordable from a comprehensive dental
PPO plan, a dental HMO plan, an affordable Value SmileSM
PPO1 plan,* or a new comprehensive Specialty
Duo dental + vision package |
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Plan
Name |
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Plan type |
PPO
|
PPO
|
PPO
|
HMO
|
Deductible |
$50
|
$50
|
$25
|
N/A
|
Calender
year max
|
$1,000
|
$1,000
|
$500
|
N/A
|
Adult
Cleanings
|
$0
|
$0
|
$0
|
$0
|
Composite
filling - one surface resin, anterior |
$37
|
$37
|
$37
|
$18
|
Crown
- porcelain fused to noble metal |
$320
|
$320
|
not covered
|
$300
|
Molar
root canal |
$234
|
$234
|
not covered
|
$290
|
Osseous
surgery per quadrant |
$263
|
$263
|
not covered
|
$303
|
Perio
root planing |
$65 |
$65 |
not covered |
$75 |
Complete
denture - upper |
$388
|
$388
|
not covered
|
$400
|
Single
tooth extraction |
$40
|
$40
|
not covered
|
$34
|
Removal
of impacted tooth - complete bony |
$113
|
$113
|
not covered
|
$125
|
Adult
Orthodontics |
$2,650
|
$2,650
|
not covered
|
$2,650
|
Child
Orthodontics |
$2,350
|
$2,350
|
not covered
|
$2,350
|
General
anesthesia |
$0 |
$0 |
not covered |
$0 |
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Specialty Duo dental + vision package
view
pdf |
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- Access to over 21,000 general care and specialty dentists in
California2
- A wide range of dental benefits, including most diagnostic and
preventive services and oral cancer screening, at no additional
cost when using a dental network provider
- Coverage even when your clients use a non-network dentist. The
plan reimburses members up to an allowed amount for covered services
and members pay the remaining balance of the total billed charges
- No waiting period for diagnostic or preventive services (3-month
waiting period for minor services; 12-month waiting period for
major restorative and orthodontic services)
- Affordable copayments for basic and major services
- Orthodontic benefits are available for both children and adults4
- $50 deductible per member, per calendar year
- $1,000 per member per calendar-year benefit maximum, of which
up to $500 per member per year can be used for non-network benefits5
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Specialty Duo dental plan1 benefits: |
- Specialty Duo dental plan1 offers
the same benefits as the Dental PPO plan above
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Specialty Duo vision plan1 benefits: |
- Access to more than 5,900 vision care providers in California2
including retail chains open on evenings and weekends.
- Choice of network or non-network vision providers
- $0 copayment for eye exams
- $25 copayment for lenses and low-vision-aids
- $100 frame allowance that can be used towards any pair of frames
- Coverage for an eye exam once every 12 months
- Coverage for lenses or contact lenses every 24 months, or 12
months with a prescription change
- Coverage for frames every 24 months
- 90-day waiting period for services
- Benefit for non-prescription sunglasses for members who have
had LASIK or PRK surgery
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|
- Access to over 21,000 general care and specialty dentists in
California2
- No charge for preventive and diagnostic plan services, including
oral cancer screening, when using network providers
- Coverage even when your clients use a non-network dentist. The
plan reimburses members up to an allowed amount for covered services
and members pay the remaining balance of the total billed charges
- No waiting periods for diagnostic or preventive services
- Affordable copayment for basic services
- $25 deductible per member, per calendar year
- $500 calendar-year benefit maximum per member5
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- Access over 9,000 dental provider locations in California2
- A wide range of dental benefits, including most diagnostic and
preventive services at no additional cost
- No deductibles and no calendar-year maximums
- No waiting periods except for a 12-month waiting period for
orthodontic services
- Affordable fixed copayments for basic and major services
- Orthodontic benefits are available for both children and adults4
- Specialty care available with a referral from a primary dentist
- Virtually no claim forms
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