2020 DENTAL DIRECT PLANS

Emilio, Kent County YMCA, Warwick

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All plans include 2 annual exams and cleanings covered at 100%, an extra cleaning for expectant mothers, and they all meet the Affordable Care Act (ACA) guidelines for pediatric dental coverage. Choose the plan that best suits your needs!

Direct Basic• Good coverage for regular checkups and

cleanings

• Costs less than $1 per day!

Direct Standard• Good coverage for regular checkups and

cleanings

• Also includes additional minor services

Direct Plus• Mid-range plans feature more

comprehensive coverage

• An affordable monthly payment

Direct Elite• Comprehensive coverage, higher benefit

• Smart choice if significant work is expected

• Higher maximum limit

BlueCrossDental 2020 PLANS

You’re going to love the Blue Cross Dental experience. Our plans are trusted and our coverage is thorough. Our dentists are local and conveniently located throughout the state. When you put your trust in Blue Cross Dental, you get great value for the money and a plan that won’t let you down!

OUR BEST-IN-CLASS DENTAL PLANS WILL PUT A SMILE ON YOUR FACE!

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As always, we provide national coverage coast-to-coast, which includes more than 100,000 dentists at more than 334,000 locations.

That means you’re covered in-network at 9 out of every 10 dentists in RI

All of our plans feature one of the largest dental networks in Rhode Island.

BLUE CROSS DENTAL

Pregnancy and oral health

Oral health can impact pregnant women as well, which is why we offer pregnant Blue Cross Dental members one extra dental cleaning per year.

Changes in hormone levels can make pregnant women more susceptible to certain conditions.And studies have shown a connection between gum disease and premature births.1

Pregnant? Visit bcbsri.com/individual/member/forms for your free cleaning coupon.

Review benefit detailsNEXT STEP:

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BLUE CROSS DENTALEvery plan includes in- and out-of-network coverage from coast-to-coast as well as pediatric dental benefits.

Benefits (over age 19) Direct Basic Direct Standard Direct Plus Direct Elite

Calendar year maximum $1,000 $1,000 $1,500 $2,000

Dependent coverage up to age 26 26 26 26

You pay You pay You pay You pay

Deductible $0 $0 $0 $50

Diagnostic and preventive services

Cleanings, oral exam, bitewing X-rays, complete X-ray series, and single X-rays

0% 0%

0% 0%

Palliative treatment (minor treatment to relieve acute pain)

50% 40%

Basic services

Fillings 50%40% 20%

20% after deductibleSimple extractions

Not covered

Denture repairs, adjustments, relines, and rebasing

50% 50%

Root canal therapy 40%*

50%*

20% after deductible*

Non-surgical periodonticsNot covered

Surgical periodontics 50% after deductible*

Oral surgery and general anesthesia

40%* 20% after deductible*

Major services

Crowns and onlays

Not covered Not covered 50%* 50% after deductible*Fixed bridges, partial and complete dentures, and single tooth implant

Oral appliances

Night guards 50% 50% 50% 50%

All plans are Qualified Dental Plans that meet the ACA guidelines for pediatric dental coverage. Please see next page for more information.* 12-month waiting period applies, which means that these services are available once your policy has been in effect for 12 continuous months.

We will accept evidence of substantially similar prior coverage to meet the waiting period requirements. You must provide the applicable information within 60 days of the requested effective date of the dental plan.

The above tables are a summary of benefits. They are not contracts. For details about coverage, including any limits and exclusions not noted here, please call our Sales Department at 1-855-690-2583 or refer to the dental plan’s subscriber agreement online at bcbsri.com/individual/member/dental.

When you go to the dentist for regular checkups, you’re not only doing something good for your mouth, you’re doing something that’s good for your whole body as well. Research shows a strong connection between oral health and overall health. Studies show that regular checkups and cleanings may reduce your risk of heart disease and stroke3, and help you and your dentist identify health risks like diabetes4 and other serious conditions at an early stage.

$1 on prevention saves as much as $50 in future costs.2

5 The above tables are a summary of benefits. They are not contracts. For details about coverage, including any limits and exclusions not noted here, please call our Sales Department at 1-855-690-2583 or refer to the dental plan’s subscriber agreement online at bcbsri.com/individual/member/dental.

Benefits Direct Basic & Direct Standard

Direct Plus & Direct Elite

You pay

In-network out-of-pocket maximum $350 individual /$700 family

Deductible $150 per person $25 per person

Cleanings*, oral exams, X-rays, fluoride treatments, space maintainers, and sealants

0%

Palliative treatment (minor treatment to relieve acute pain)

20%

Fillings 50% after deductible

Simple extractions, partial/denture repairs, relines and rebasing, periodontal treatments, root canals, oral surgery, crowns and prosthodontics

75% after deductible

50% after deductible

Orthodontics (medically necessary only)

50% after deductible

Night guards 50%

No waiting period for pediatric dental benefits. * Cleanings: Direct Basic & Direct Standard - 2/year, Direct Plus & Direct Elite - 3/year

Age Direct Basic Direct Standard Direct Plus Direct Elite

0-18 $22.21 $22.21 $36.22 $36.22

19-29 $17.11 $22.29 $34.56 $45.14

30-39 $17.11 $22.29 $34.56 $45.14

40-49 $17.11 $22.29 $34.56 $45.14

50-59 $18.82 $24.52 $38.02 $49.65

60 + $21.38 $27.86 $43.20 $56.42

Rates are determined per individual. The premium rate for family coverage is based on the number of individuals in the family that enroll in coverage and the age of each family member. If you have children and they are covered under the plan, you will only pay a premium for the three oldest children under the age of 21.

Blue Cross Dental Direct monthly rates

And children lose 52 million school hours per year due to dental problems. To keep their teeth healthy, children should visit the dentist for a cleaning TWO times per year, and they should brush and floss TWO times a day for TWO full minutes!5

Pediatric dental benefits (up to age 19)

We're here to helpNEXT STEP:

More than

50%

of all American

children will be affected

by tooth decay before

age 5

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Contact us at (401) 459-5550 or 1-855-690-2583 (my0blue) (TTY: 711) for assistance and an enrollment form.

READY TO ENROLL?

Come by Your Blue StoreSM retail locations

Sometimes you just want to talk face-to-face. Only BCBSRI offers convenient locations in East Providence, Lincoln, and Warwick. Get answers to your questions, plus take advantage of free services like:

• Available on-site nurses

• Community and wellness events

• Health screenings and classes

Call

Three easy ways to sign up

Online at bcbsri.com/individual/shop/dental/2020 We’ve made shopping for a plan easier than ever, and we have many sources on our website to help answer your questions.

Click

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EAST PROVIDENCEHighland Commons71 Highland Avenue

WARWICK Cowesett Corners300 Quaker Lane

LINCOLNLincoln Mall Shopping Center 622 George Washington Highway

Your Blue StoreSM retail locations

Muriel, Your Blue Store, East Providence

Find a network DentistNEXT STEP:

500 Exchange Street • Providence, RI 02903-2699

Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association.

09/19 BCD-300316•3132

www.bcbsri.com

1 Centers for Disease Control and Prevention https://www.cdc.gov/oralhealth/publications/features/pregnancy-and-oral-health.html

2The University of Illinois at Chicago College of Dentistry https://dentistry.uic.edu/blog/value-preventive-oral-health-care

3 Harvard Health Publishing https://www.cdc.gov/oralhealth/publications/features/pregnancy-and-oral-health.html

4 American Dental Association https://www.ada.org/en/publications/jada/jada-specialty-scans/periodontics/071516_perio

5 American Academy of Pediatric Dentistry, State of Little Teeth https://www.aapd.org/assets/1/7/State_of_Little_Teeth_Final.pdf

Finding and comparing dentists in the Blue Cross Dental network is easy:

1. Go to bcbsri.com/find-doctor

2. Click on “Find a Dentist”

3. Enter your search criteria, and be sure to choose “Dental Coast-to-Coast” as the network

Footnotes

NEED A DENTIST?Here’s how to find a network dentist: