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BlueSelect® Dental |
Dental Plus BlueTraditional® |
Dental Plus PPO |
| Selection of Dentists |
Each subscriber chooses a dentist from a broad list of participating dentists statewide. |
Each subscriber chooses a dentist from a broad list of participating dentists statewide. |
Each subscriber chooses a dentist from a list of hundreds of dentists statewide. |
| Deductible |
$50 deductible. |
Deductible options of $0, $50 or $100. |
Deductible options of $0, $50 or $100. |
| Maximum Benefit |
Annual maximum benefit of $1,000 (Options 1A, 2 and 3) or $1,250 (Option 4) on primary and major services. |
Annual maximum benefit of $1,000 on primary and major services. |
Annual maximum benefit of 1,000 on primary and major services. |
Diagnostic and Preventive Services |
Routine cleanings, x-rays, oral exams, children's fluoride applications, space maintainers and sealants covered at 100% of maximum reimbursement allowance with in-network dentists; 80% of maximum reimbursement allowance with out-of-network dentists. |
Routine cleanings, x-rays, oral exams, children's fluoride applications, space maintainers and sealants covered at 100% of maximum reimbursement allowance. |
Routine cleanings, x-rays, oral exams, children's fluoride applications, space maintainers and sealants covered at 100% of the pre-negotiated PPO price when using Dental Plus PPO dentists. Subject to 80% coinsurance of the pre-negotiated PPO price when using a non-participating Dental Plus PPO dentist. |
| Primary Services (maintenance, oral surgery and periodontic services). |
Paid at 80% of the pre-negotiated price when using LINCS Dental Connection network dentists. Paid at 60% of the pre-negotiated price when using non-network dentists. |
Paid at 80% of the network pre-negotiated price. |
Paid at 80% of the pre-negotiated PPO price when using PPO dentists. Paid at 60% of the pre-negotiated PPO price when using non-PPO dentists. |
| Major Services (inlays, crowns, veneers, dentures, partials and bridges) |
Paid at 50% of the pre-negotiated price when using LINCS Dental Connection network dentists. Paid at 30% of the pre-negotiated price when using non-network dentists.
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Paid at 50% of the network pre-negotiated price. |
Paid at 50% of the pre-negotiated PPO price when using PPO dentists. Paid at 30% of the pre-negotiated PPO price when using non-PPO dentists. |
| Orthodontics (Available to groups with 50 or more enrolled employees.) |
Optional: Available only to eligible dependents to age 19. Paid at 50% of the pre-negotiated price when using network dentists. Paid at 30% of the pre-negotiated price when using non-network dentists. Subject to $1,000 lifetime maximum benefit. (Options 2, 3 and 4 only.) |
Optional: Available only to eligible dependents to age 19. Paid at 50% of the network pre-negotiated price. Subject to $1,000 lifetime maximum benefit. |
Optional: Available only to eligible dependents to age 19. Paid at 50% of the pre-negotiated PPO price when using PPO dentists. Paid at 30% of the pre-negotiated PPO price when using non-PPO dentists. Subject to $1,000 lifetime maximum benefit. |