premium table below. Call: 833-901-1364 Learn more. A summary of benefits and coverage explains things like what a health insurance plan covers, what it doesn't cover, and what your share of costs will be. Register Now, Not registered? Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. PDF REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form The process of obtaining all the information necessary to determine the appropriate amount to pay on a given claim. June 17, 2022 . Visit www.bcbsmt.com/member 2. A coding inconsistency that involves separating a procedure into parts and charging for each part rather than using a single code for the entire procedure. A set of specialized healthcare services that provide support to terminally ill patients and their families. To learn more about dental benefits for STAR children, see the STAR Member Handbook. There is a deductible for Class II and III services only. We have several tools and resources available to help you make informed decisions about your plan and make the most of your BCBS FEP Dental coverage. HealthEquity is our business associate and is an independent company that provides account-based plan services to Blue Cross. BlueCard applies if the provider of service is outside the member's Blue Cross Blue Shield Plan's service area and does not contract with the member's Plan. PDF Your Health Care Benefit Program 0000003753 00000 n 2 0 obj <>/Metadata 7 0 R/Names 8 0 R/OpenAction 6129 0 R/Outlines 6130 0 R/PageLayout/OneColumn/PageMode/UseOutlines/Pages 838 0 R/StructTreeRoot 2595 0 R/Type/Catalog/ViewerPreferences<>>> endobj 3 0 obj <>/Font<>>>/Fields[]>> endobj 7 0 obj <>stream r9J2InHV`@Lb`\a%diF`3200h f`ig`` a 0000047131 00000 n Cleanings are covered three times a year. 00421 Personal Health and Dental Plan - Pacific Blue Cross An organization that provides dental care to its members through a network of dentists who offer discounted fees to the plan members. Outside the United States. Check out our Member Education Materials to get more information aboutBlue Cross Although you can go to any dentist of your choice, your benefits under BlueCare Dental PPO Rider will be greater when you use the services of an in-network dentist. A toll-free number, 1-800-676-BLUE, for healthcare providers to verify Blue Cross Blue Shield membership and coverage information for patients. Members receive a higher level of benefits when they use in-network providers than if they use out-of-network providers. For dental care, you can go to any licensed dentist and this plan will share the cost. PPOs have lost some of their popularity in recent years as health plans reduce the size of their provider networks and increasingly switch to EPOs and HMOs in an effort to control costs. You pay50%after deductible before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. 0000011650 00000 n 0000041318 00000 n 0000139581 00000 n Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. 0000006097 00000 n Major services like crowns and bridges. 0000009079 00000 n Members fund their FSAs with contributions that come out of their paycheck. Members choose in-network care or out-of-network care at the time they make their dental appointment and usually incur higher out-of-pocket costs for out-of-network care. Basic services like fillings and root canals. Services may be provided from a single site or from multiple locations. IyaPC96>$i}KFVLWEs$g;iQrij:J]#b]Fd`0c;TU\5ZXyZbb{l I6Be6i^f+viqy .px8~N If you're considering enrolling in one of our individual and family plans, learn a bit more about the coverage you'll receive. 0000002422 00000 n A healthcare system that assumes or shares both the financial risks and the delivery risks associated with providing comprehensive medical services to a voluntarily enrolled population in a particular geographic area, usually in return for a fixed, prepaid fee. Also known as preventive care programs or wellness programs. Accounts that employers can establish for employees to reimburse a portion of their eligible family members' out-of-pocket medical expenses, such as deductibles, coinsurance and pharmacy expenses. - Coverage for children up to the end of the month in which the member turns 19. . This is the limit on what your plan pays for dental care benefits for members who are 19 or older when their plan starts. General medical care that is provided directly to a patient without referral from another physician. An extension of the Blue Cross Blue Shield WalkingWorks program, this event helps people incorporate physical activity into their workday and encourages them to increase their daily physical activity by walking at lunch. In group health insurance, generally a condition for which an individual received medical care during the three months immediately prior to the effective date of coverage. Limited to three times a year in combination with routine cleaning. A computerized record of a patient's clinical, demographic and administrative data. An itemized statement of healthcare services and their costs provided by a hospital, physician's office or other provider facility. You are leaving this website/app (site). BlueCare Dental is a portfolio of standard dental preferred provider option (PPO) benefit plan designs BlueCare Dental Freedom SM and BlueCare Dental Choice SM. %PDF-1.6 % PDF Outline of Coverage - Blue Cross Blue Shield of Massachusetts In addition, some sites may require you to agree to their terms of use and privacy policy. A free-standing center that performs various types of surgery. A medical care center that provides a wide range of healthcare services, including preventive care, acute care, surgery and outpatient care, in a centralized facility. Fluoride treatments The plan features comprehensive and flexible options for coverage across three levelsGold, Silver, and Bronzeas well as some exciting new benefits that promote health equity in our province. Member Discounts Take advantage of member-only discounts on health-related products and services. Free language assistance to people whose primary language is not English, such as: Calling Blue Cross Blue Shield FEP Dental at 1-855-504-BLUE (2583), dial 711 for TTY relay services. +3. Here's what's new for 2023: For High Option members, you will pay nothing for in-network Class B and C services for children 13 and under. An application for payment of benefits under a health plan. Treatment that is provided to a patient who is able to return home after care without an overnight stay in a hospital or other inpatient facility. 0000045487 00000 n Download or print your benefit information. A method of planning and implementing quality management programs that consists of identifying the best practices and best outcomes for a specific process and emulating the best practices to equal or surpass the best outcomes. A review program that evaluates whether drugs are being used safely, effectively and appropriately. Provides greater healthcare transparency by delivering detail about healthcare trends and best practices, resulting in healthier lives and affordable access to safe and effective care. These documents also show your estimated costs for two sample medical events: having a baby and managing diabetes. 0000041910 00000 n A group of healthcare providers that agrees to deliver coordinated care, meeting performance benchmarks for quality and affordability in order to manage the total cost of care for their member populations. Up to $800 of the $1,200 in-network total can be used toward out-of-network care. 0000005030 00000 n HTF>QP13V2Y!QLS=k *Bl~DF*iU&!Tg))a,py7!-p{&1 !$=^S2`;bFp: v}-+OJ9bx0%M{ih,,D-O4oF$>N-fbh gj]N^|w&r~XF#81e{Ta33=gKI. 0000107951 00000 n e.g., oral surgery, fillings, gum scaling, e.g., crowns, bridges, implants, root canals, dentures, Premium Standard Options Chart - Self Only, Average Cost Savings Chart - What you pay with High Option, Standard and High Option Plan Benefits and Premiums. 0000022849 00000 n 0000039957 00000 n Register Now. Free aids and services for people with disabilities to communicate effectively with us, such as: Written information in other formats (such as accessible electronic formats). 0000005103 00000 n Please refer to your Dental Benefit Booklet for additional benefit information. 0000005327 00000 n However, the lower benefit plan level will apply and out-of-pocket expenses will be higher when receiving dental services from dentists not in the BlueCare DentalSM network. In addition, some sites may require you to agree to their terms of use and privacy policy. Access educational information on a wide range of dental topics including pediatric care, prevention and dental treatments. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. Calling BlueCard Eligibility will facilitate efficient payment for the provider. The Medicare component that provides benefits to cover the costs of physicians' professional services, whether the services are provided in a hospital, a physician's office, an extended-care facility, a nursing home or an insured's home. This new site may be offered by a vendor or an independent third party. If you are a BCBSTX STAR member and you would like to receive or learn more about dental services for adults ages 21 and older, please call DentaQuest directly for assistance. Important Legal and Privacy Information|Important Information About Medicare Plans|Privacy Practices Leading the way in health insurance since 1929. If you continue to use this site we will assume that you are happy with it. 0000036033 00000 n Adults in the BCBSTX STAR plan are not covered on the above dental plans. The designation is based on evidence-based, objective selection criteria established with input from expert physicians and recommendations from medical organizations . The health plan physician executive who is responsible for the quality and cost-effectiveness of the medical care delivered by the plan's providers. Blue Cross Blue Shield companies provide a best-in-class, comprehensive suite of international products and services for people who live, work and travel internationally, giving them confidence that quality care can be accessed wherever and whenever they need it. BlueCare Dental ConnectionSM is a program benefit that provides members with education and intervention through support tools and educational mailings. 0000003305 00000 n TTY users dial 711. Fully-Insured Small Group Summary of Dental Benefits. Call us at1-855-237-3501. There is no waiting period for Class I services. The site may also contain non-Medicare related information. 0000000016 00000 n Federal Programs. The Blue Cross Blue Shield Grievance Cleanings are covered twice a year. Limited to twice a year in combination with routine cleaning. 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Once you have identified your rating area, you can view premium amounts for our available plans in the BlueCard Enables members to receive healthcare services wherever they live or travel, nationally or internationally. We use cookies to ensure that we give you the best experience on our website. Patients and Blue Cross Blue Shield Arizona members can contact Blue Cross Blue Shield Arizona or its affiliated health plan using the phone number on the back of their insurance card with questions or reach out to memberhelp@azblue.com. We provide health insurance in Michigan. 0000072854 00000 n 0000015769 00000 n Does Blue Cross and blue shield of Texas (bcbstx) have a dental Wellness Center? 0000005867 00000 n The provider of service is the one who files a claim for a service supplied to the member. Also known as a group practice model HMO. Individuals attempting unauthorized access will be prosecuted. What is Pdent? - Shabupc.com 0000059838 00000 n Why Blue Cross Blue Shield dental connections? The BlueCare Dental PPO product is a product available for purchase on a self-funded basis only. A health maintenance organization (HMO) that contracts with a group of physicians with multiple specialties who are employees of the group practice. The group must also offer an alternate dental option to HMO. Glossary | Blue Cross Blue Shield These cards assist PBMs in processing and tracking pharmaceutical claims. President of Blue Cross and Blue Shield of Texas The Dental Schedule of Coverage enclosed with this Benefit Booklet indicates benefit percentages, Deductibles, maximums, and other benefit and payment issues that apply to the Plan. Box 986030, Boston, MA 02298. Space maintainers Traditional insurance, also known as Indemnity or Fee-for-Service, allows members to select any healthcare provider for services. hb```e`` l@Q>l e I#r^ Learn more about dental services for adult STAR members, 8 a.m. to 5 p.m. Central Time Monday through Friday. BCBS FEP Dental is here to help you learn more about your oral health. Select "Log In To My Account" from the large center banner A large pool of individuals for which health coverage is provided by the group sponsor. Register Now, Not registered? 0000008069 00000 n X~ )T`2*>+;NC][i\3{- GWn.gr7NrYa?5*~'sfn:6hV-_b{. application/pdf Log in and look. After reaching that limit for the year, you pay for 100% of your dental care. An evaluation of the medical necessity, appropriateness and cost-effectiveness of healthcare services and treatment plans for a given patient. We provide health insurance in Michigan. This program provides members with education and intervention through support tools and educational mailings. One option is Adobe Reader which has a built-in reader. 0000003994 00000 n See also precertification. 0000006103 00000 n Children can get pediatric benefits until the end of the calendar year in which they turn 19. 15 0 obj <> endobj xref PDENT is your dental plan. BlueCare Dental Connection integrates dental care management and health care management with a focus on preventive care and individual involvement. Need help understanding and choosing a benefit plan? After a 12-month waiting period, cover is extended to major procedures including dentures, implants, crowns and orthodontics - all subject to an annual maximum of $1,500. A Medicare supplement that uses a preferred provider organization (PPO) to supplement Medicare Part B coverage. Pacific Blue Cross has available coverage for health, dental and emergency medical travel.

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