2016 Stand Alone Pediatric & Adult Dental Plans

 

BlueCross BlueShield of Western New York offers stand-alone pediatric and adult dental plans for individuals administered by us effective January 1, 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. 

View Pediatric and Adult 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 tool for our Pediatric & Adult Dental Plans -  You can search by specialty, zipcode, city, county or state. Just select "Dental Providers" in the dropdown.

 

   Blue Pediatric Dental* (PPO)
 Blue Value Dental 1* (PPO)  Blue Value Dental 2 (PPO)
Monthly premium $19.83 (per child) $20.11 (one adult)
$40.23 (two adults)
$51.31 (subscriber and child(ren))
$71.82 (family)
$25.06 (one adult)
$50.11 (two adults)
$59.28 (subscriber and child(ren))
$84.23 (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% coinsurance 50% coinsurance after deductible 50% coinsurance after deductible
Orthodontia
(medically necessary; routine braces not covered)
50% coinsurance Not covered Not covered
Annual maximum
N/A $750 per member, per calendar year $1,000 per member, per calendar year
Out-of-pocket maximum $350 - 1 child
$700 - 2 or more children
(per calendar year)
N/A N/A
       
       
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Non-participating provider services are not covered except as required for emergency care.

*Available on NY State of Health Marketplace

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

2015 Stand Alone Pediatric & Adult Dental Plans

 

BlueCross BlueShield of Western New York offers stand-alone pediatric and adult dental plans for individuals. Our plans provide essential health benefits to ensure members receive comprehensive oral health coverage. We partner with and utilize the HealthPlex network to service our Adult and Pediatric plans. HealthPlex is the largest dental benefits administrator in New York. These plans will no longer be available as of January 1, 2016. 

View Pediatric and Adult Plan Overviews

Looking for a dental provider?  You can search by specialty, zipcode, city, county or state. 
Find a Dental Provider for our Pediatric & Adult Dental Plans

 

   Blue Pediatric Dental
 Blue Value Dental*
Monthly Premium $15.78
For more than one child, multiply rate by number of children
$17.02 (1 adult)
$34.89 (2 adults)
$38.30 (subscriber and children)
$61.27 (family)
Deductible None $50 benefit specific deductible (individual)
Out-of-Pocket Limit $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 copaymentpreventive/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 and:
       Fillings
       Crowns
       Other restorative materials
$0 copaymentpreventive/diagnostic visit for services including:
       Dental exam
       Cleaning
       Diagnostic x-rays

50% coinsurance after deductible and 6 month waiting period for:
Simple extractions and routine dental surgery and:
       Fillings
       Denture and bridge repair
       Periodontics
Major Dental (Endodontics and Prosthodontics) 50% coinsurance
50% coinsurance after deductible and six month waiting period.

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.
     
     
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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 the Blue Pediatric Dental in order to meet essential health benefit requirements