Blue Cross Blue Shield FEP Dental
Section 3 How You Obtain Care
Section 3 How You Obtain Care
Example 2: High Option coverage (Out-of-Network provider). This example assumes all deductibles have been met and annual maximums have not been reached.
BCBS FEP Dental member with FEHB coverage – FEHB is always primary
Services are provided by an Out-of-Network Provider
1-surface filling: $108.00*
FEHB payment (estimated): $16.00
BCBS FEP Dental benefits payable in the absence of FEHB coverage: $64.80 ($108.00 at 60%)
Payment by BCBS FEP Dental: $64.80
Member’s responsibility: $27.20 ($108-$16-$64.80=$27.20)
*Assumes provider charge is within the Maximum Allowed Amount
Services are provided by an Out-of-Network Provider
1-surface filling: $108.00*
FEHB payment (estimated): $16.00
BCBS FEP Dental benefits payable in the absence of FEHB coverage: $64.80 ($108.00 at 60%)
Payment by BCBS FEP Dental: $64.80
Member’s responsibility: $27.20 ($108-$16-$64.80=$27.20)
*Assumes provider charge is within the Maximum Allowed Amount