Blue Cross Blue Shield FEP Dental
General Services
General Services
General Services
Important things you should keep in mind about these benefits:
You Pay:
High Option
Standard Option
- Please remember that all benefits are subject to the definitions, limitations, and exclusions in this brochure and are payable only when we determine they are necessary for the prevention, diagnosis, care, or treatment of a covered condition and meet generally accepted dental protocols.
- The calendar year deductible is $0, if you use an in-network provider.
- If you elect to use an out-of-network provider, the Standard Option has a $75 deductible per person; High Option has a $50 deductible per person. Neither Option contains a family deductible, each enrolled covered person must satisfy their own deductible.
- There is no High Option Annual Benefit Maximum for non-orthodontic in-network services, and $3,000 for out-of-network services.
- The Standard Option Annual Benefit Maximum for non-orthodontic services is $1,500 for in-network services and $750 for out-of-network services. In no instance will BCBS FEP Dental allow more than $1,500 in combined benefits under Standard Option in any plan year.
- All services requiring more than one visit are payable once all visits are completed.
- The following list is an all-inclusive list of covered services. BCBS FEP Dental will provide benefits for these services, subject to the exclusions and limitations shown in this section and Section 7.
You Pay:
High Option
- In-Network: No deductible; you pay 30% of the plan allowance for covered services as defined by the plan subject to plan maximums.
- Out-of-Network: $50 deductible; you pay 40% of the plan allowance for covered services as defined by the plan subject to plan maximums and any difference between our allowance and the billed amount.
Standard Option
- In-Network: No deductible; you pay 45% of the plan allowance for covered services as defined by the plan subject to plan maximums.
- Out-of-Network: $75 deductible; you pay 60% of the plan allowance for covered services as defined by the plan, subject to plan maximums and any difference between our allowance and the billed amount.