2017 Pediatric & Adult/Family Dental Plans

 

BlueCross BlueShield of Western New York offers stand-alone pediatric and adult dental plans for small groups.  Our plans provide essential health benefits to ensure members receive comprehensive oral health coverage through our own dental network. 

  • New for 2017 - Blue Value Dental 3, a richer plan with coverage for cosmetic orthodontics (routine braces) for children and adults. 
  • Pediatric Dental is an Essential Health Benefit as outlined in the Affordable Care Act. 
  • Groups can choose one Blue Value dental plan to offer their employees in addition to Blue Pediatric dental. 
  • Flexibility to see out-of-network dentists.

View all Pediatric and Adult Dental Plans

View Blue Pediatric Dental

View Blue Value Dental 1

View Blue Value Dental 2 

View Blue Value Dental  3

 

Looking for a dental provider?  

Use our Find a Provider search tool for our Pediatric & Adult Dental Plans - You can search by specialty, zip code, city, county or state.  Just select "Dental Providers" in the dropdown.

 

 

Dental benefits Blue Pediatric Dental* (PPO) Blue Value Dental 1* (PPO)
Blue Value Dental 2 (PPO)
Blue Value Dental 3*** (PPO)
Monthly Premium

$19.14 (per child) $18.03 (one adult)
$36.06 (two adults)
$46.99 (subscriber and child(ren))
$75.09 (family)
$24.18 (one adult)
$48.36 (two adults)
$56.54 (subscriber and child(ren))
$91.81 (family)
$27.85 (one adult)
$55.70 (two adults)
$63.83 (subscriber and child(ren))
$103.96 (family)
Benefits Children to age 19 years Adult/Family** Adult/Family** Adult/Family**  
Deductible (embedded) N/A $50 per member/$150 family maximum  $50 per member/$150 family maximum  $50 per member/$150 family maximum   
Annual benefit maximum N/A $750 per member per plan year $1,250 per member per plan year $1,500 per member per plan year  
Out-of-pocket maximum $350 - one child
$700 - two or more children (per plan year)
N/A N/A N/A  
Orthodontic lifetime maximum
(pediatric and adult cosmetic, routine braces)
N/A N/A N/A $1,000 per member per lifetime  
Preventive/Diagnostic Care
(exams, cleanings, x-rays)
$20 copay per visit $0 copay per visit $0 copay per visit $0 copay per visit  
Basic restorative
(fillings, extractions, periodontics, endodontics)
50% coinsurance 50% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible
Major dental
(bridges, crowns, dentures)
50% coinsurance 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible
Orthodontics

50% coinsurance
(medically necessary only; routine braces not covered), subject to out-of-pocket max
 
Not covered
 
Not covered
 
50% coinsurance (adult and pediatric cosmetic orthodontics), subject to lifetime max

 
         
 
 





   
 

 

 

 

Note: Members can receive dental services from a provider who does not participate in the BlueCross BlueShield contracted network of providers. Out-of-network services are reimbursed at 100% of the in-network fee schedule and the non-participating provider may balance bill the member for the remainder. 

*Available on SHOP

**Blue Pediatric dental benefits and cost-sharing are included in all Blue Value dental plans. Pediatric Dental is an essential health benefit as outlined in the Affordable Care Act. As an insurer, we are required to make our best efforts to ensure that you obtain this coverage.  

***Blue Value Dental 3 includes coverage for children up to age 19 for medically necessary orthodontics subject to an out-of-pocket maximum (see Blue Pediatric Benefits) and cosmetic orthodontics (routine braces) subject to a lifetime maximum per member. Adults and adult dependents have coverage for cosmetic orthodontics (routine braces) subject to a lifetime maximum per member. 

2017 Dental Contracts

Small Group Dental Contracts from BlueCross BlueShield of Western New York (OFF Exchange)

Small Group ON Exchange Contracts

2016 Pediatric & Adult Dental Plans

 

BlueCross BlueShield of Western New York offers stand-alone pediatric and adult dental plans for small groups administered by us effective on the group's renewal date in 2016.  Our plans provide essential health benefits to ensure members receive comprehensive oral health coverage through our own dental network. This replaces our former Healthplex offering. You now have flexibility to see out-of-network dentists. You will have one ID card when you also have a medical plan with us.

View Pediatric and Adult Dental Plans

View Blue Pediatric Dental

View Blue Value Dental 1

View Blue Value Dental 2 

Looking for a dental provider?  
Use our Find a Provider search tool for our Pediatric & Adult Dental Plans - You can search by specialty, zipcode, city, county or state.  Just select "Dental Providers" in the dropdown.

 

Dental benefits Blue Pediatric Dental* (PPO) Blue Value Dental 1* (PPO)
Blue Value Dental 2 (PPO)
Monthly Premium $18.21 (per child) $17.90 (one adult)
$35.79 (two adults)
$46.18 (subscriber and child(ren))
$64.50 (family)
$22.19 (one adult)
$44.39 (two adults)
$53.11 (subscriber and child(ren))
$75.29 (family)
Deductible N/A $50 per member
Applies to basic restorative and major dental services
$50 per member
Applies to basic restorative and major dental services
Preventive/diagnostic care
(exam, cleaning, X-rays)
$20 copayment $0 copayment $0 copayment
Basic restorative
(fillings, extractions, periodontics, endodontics)
50% coinsurance 50% coinsurance after deductible 20% coinsurance after deductible
Major dental
(prosthodontics, crowns, dentures)
50% 50% coinsurance after deductible 50% coinsurance after deductible
Orthodontia
(medically necessary, routine braces not included)
50% coinsurance Not covered Not covered
Annual maximum N/A $750 per member, per plan year $1,000 per member, per plan year
Out-of-pocket maximum $350 - 1 child
$700 - 2 or more children (per plan year)
N/A N/A
       
     
  Shop Plans

Shop Plans

 
 

 

 

 

Non-participating provider services are not covered except as required for emergency care.

 

*Available on SHOP

Note: Blue Pediatric dental benefits and cost-sharing are included in all Blue Value dental plans.

 

 

   Blue Pediatric Dental
Blue Value Dental*
Monthly premium $15.78 (per child)
For more than one child,
multiply rate by number of children
$ 16.41 (employee)
  $ 33.64 (employee & spouse/domestic partner)
$36.92 (employee & children)
$59.08 (family)
Deductible None $50 benefit specific deductible (individual)
Out-of-Pocket maximum $350 (one child) / $700 multiple children Unlimited
Benefit maximum
N/A $750 per member, per plan year 
Preventive/routine dental care
*One dental exam and one cleaning per six month period
$20 copayment per preventive/diagnostic visit for services including:
       Dental exam
       Cleaning
       Topical fluoride
       Sealants
       Space maintainers
       Diagnostic x-rays

   50% coinsurance for:
       Simple extractions and routine dental surgery
       Fillings
       Crowns
       Other restorative materials
$0 copayment per preventive/diagnostic visit for services including:
       Dental exam
       Cleaning
       Diagnostic x-rays

50% coinsurance after deductible for:
       Simple extractions and routine dental surgery
       Fillings
       Denture and bridge repair
       Periodontics

Major Dental

(Endodontics and Prosthodontics)

50% coinsurance 50% coinsurance after deductible
Orthodontia 50% coinsurance 50% coinsurance after deductible (for members up to age 19)
  Non-participating provider services are not covered except as required for emergency care. Non-participating provider services are not covered except as required for emergency care.
     
     
  SHOP plans

SHOP plans

 

 

 

Non-participating provider services are not covered except as required for emergency care.

*All children under the age of 19 enrolled in Blue Value Dental will be covered under Blue Pediatric Dental in order to meet essential health benefit requirements.