BlueCare Dental PPO offers an expansive local network of dentists with more than 13,000 access points in Illinois, and more than 378,000 nationwide.
Nine service categories are covered by the plan:
- Diagnostic & Preventive Services
- Miscellaneous Services
- Restorative Services
- General Services
- Endodontic Services
- Periodontic Services
- Oral Surgery Services
- Crowns, Inlays/Onlays Services
- Prosthodontic Services
In addition, coverage for orthodontics is provided for adults and children. Benefits are limited to a lifetime maximum for each eligible member, depending upon the plan chosen for your employees.
In a PPO plan, costs are typically reduced when members receive care from network providers. Dentists in the DPPO network have agreed to pre-determined fees for their services. The plan’s Schedule of Maximum Allowances (SMA), on average, is lower than usual fees. Because of this, Blue Cross and Blue Shield of Illinois is able to offer dental plans with:
- competitive premiums
- savings for employers and their employees
- out-of-network claims paid at SMA or usual and customary (U&C)
Members realize the most savings when care is received from PPO dentists. Members pay less out-of-pocket and will not be balanced billed. They can also see any dental specialist within the network without a referral.
Dental PPO Plan Options – Passive PPO and PPO
We offer "passive" dental PPO plans, where the benefit level is the same for both network and non-network dentists. Passive plan options pay out-of-network dental services at U&C.
We also offer two Dental PPO benefit structures. Both benefit plan options pay network dentist at SMA; however, one plan pays out-of-network dentists at SMA and the other pays at U&C.
With either plan option, employees have the freedom to select a dentist from outside the network and still be covered. When the plan pays non-PPO dentists at U&C, the employer savings are less, employees are balanced billed and their out-of-pocket costs are slightly higher.
After enrollment, members will receive a BlueCare Dental PPO ID card to present at their dental visit.