BlueCare® Dental HMO (DHMO)
The BlueCare DHMO plan encourages you to maintain good dental health by offering full coverage for preventive and diagnostic care.
Through BlueCare DHMO, you and your eligible family members can each select a network dentist to provide and coordinate dental care. When you visit your selected dentist, preventive and diagnostic care is covered at 100 percent. There is no deductible, no out-of-pocket cost and no claim forms to fill out. You will typically pay less for dental services with a dental HMO than you would with other dental plans.
BlueCare DHMO has one of the largest networks of contracting dental HMO providers in Illinois. Dentists in the BlueCare DHMO network have agreed to accept lower, predetermined fees for covered services.
After enrollment, you will receive a wallet card to indicate your dental eligibility when visiting a BlueCare DHMO dentist.
In network dentists receive eligibility information the first of each month.
BlueCare DHMO offers a dental network that is one of the largest in Illinois. The BlueCare DHMO network includes contracting specialists such as oral surgeons, orthodontists, pediatric dentists, endodontists (specialists in diseases of the nerve within the tooth) and periodontists (specialists in diseases of the gums and tissues). If you need specialty care, the contracting dentist will make a referral. This is required to receive benefits.
Each dentist and facility is evaluated through a credentialing process before being accepted into the network and all network dental offices are periodically reviewed.
A complete list of contracting general dentists can be found online by visiting the Dental Provider Finder . You can search for a network dentist near your home or office, and conveniently download a map and driving directions. You can also contact customer service at (800) 323-7201 for assistance in locating a network dentist.
Provider changes made by the 20th of the month are effective the first day of the following month.
Visiting A Dentist
To receive BlueCare DHMO benefits, you and your eligible dependents must receive care from a provider contracted in the BlueCare DHMO network.
If your current dentist is not contracted in the BlueCare DHMO network, to receive covered services, you and each of your eligible dependents must select a new dentist from the contracting network to provide and coordinate all dental care.
If dental specialty care is needed, your BlueCare® dentist will provide a referral to a specialist from the network. If there is no appropriate contracting specialist within 35 miles of your home, the dentist may refer you to a non-network specialist.
For services to be covered, you must call customer service to obtain prior authorization to see the referred specialist. If care is received from a non-network specialist — without prior approval — you will be responsible for the full cost.
Selecting and Changing Dentists
To select or change to a new contracting dentist, you can use the online Dental Provider Finder and complete the Dental Center Selection/Change Form. You can also call customer service at (800) 323-7201 for assistance in transferring to a new dentist.
Provider changes made by the 20th of the month are effective the first day of the following month. You also can nominate a dentist to participate in the BlueCare DHMO network by completing the online Provider Nomination Form.
Blue Cross and Blue Shield of Illinois is pleased to offer BlueCare Dental Connection, a proactive approach that protects more than just teeth. BlueCare Dental Connection provides resources to help encourage you to manage their oral health, which may help improve your overall health.
Research shows a potential link between periodontal disease and other health problems such as heart disease, stroke, diabetes control and premature birth. When it comes to helping you take care of oral health and overall health, administering dental benefits is a starting point. More than ever it’s critical to:
- Apply the knowledge gained from evidence-based dental research
- Create consumer-driven tools specific to dental care and dental benefits
- Use disease management concepts to target members most in need of dental care
BlueCare Dental Connection, includes access to The Dental Wellness CenterTM , a source of online resources and support tools allowing you to:
- Ask licensed dentists dental-related questions through Ask A Dentist
- Locate a network general dentist or specialist with Provider Finder®
- Determine approximate dental fees in the marketplace with the Dental Cost AdvisorTM (requires secure log in to Blue Access for EmployersSM)
In addition, educational information is available on a wide range of dental topics including pediatric care, prevention and dental treatments. You can access the online features of BlueCare Dental ConnectionTM, by logging on to Blue Access for MembersSM.