Health Insurance Marketplace: Changes to Dental Coverage

Health Insurance Marketplace: Changes to Dental Coverage

3/25/2015

Effective January 1, 2015, BlueEssentialsSM and Blue OptionSM (formerly MyChoice® Advantage) plans no longer use the participating dental network. These plans also no longer offer pediatric dental coverage. Previously, coverage included preventive and restorative dental care for children under age 20. Individuals interested in additional stand-alone dental coverage can purchase it.  They can buy it on the Federally Facilitated Marketplace at www.HealthCare.gov.

Blue Option does provide a dental allowance for adult and children exams. It also provides a cleaning as a value-added service that does not apply toward the maximum out of pocket (MOOP). Members can take advantage of this benefit when using any licensed dentist.

Adults:

  • One exam every six months - $27 allowance for the initial exam and a $20 allowance for periodic exams
  • One cleaning every six months - $40 allowance

Children:

  • One exam every six months - $27 allowance for the initial exam and a $20 allotel:1-803-264-4730wance for periodic exams
  • One cleaning every six months - $31 allowance

Members are responsible for paying any additional balance over the dental allowance and submitting a reimbursement form. For example, if you charge $80 for an initial exam, members will pay $80 at the time of service. We will reimburse members $27 once we receive the reimbursement form. This form is available at www.BlueOptionSC.com.

Please contact Provider Education for information about this bulletin at provider.education@bcbssc.com or by calling 803-264-4730.