Blue Shield of California's dental plans provide your clients with a variety of rate and benefit options, most with no waiting periods. Your clients can select coverage for all employees – even those not enrolled in our health plans.
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We’ve developed a simplified portfolio of dental PPO plans to help streamline your sales experience.
The new dental PPO plans are easy to navigate with a clear hierarchy that helps find buy-up and buy-down options and follow medical plan naming convention (bronze, silver, gold, platinum, diamond). The changes, initiatives, and enhancements covered here are effective January 1, 2022. Some of the competitive benefits included are:
Introducing 22 new DPPO plans with five categories with a naming convention that mirrors the medical plans:
Existing 2021 marketed DPPO plans will change to non-marketed status and will be closed for new business. Renewing groups may continue to renew into the same plan or chose one of the new 22 plans available at renewal.
Rates for closed plans can be found by looking up the plan ID number in our rate manual under “Closed Rate Book – includes closed Specialty (all regions: 1-19).”
Additional dental benefits changes
Good oral health is important not only to prevent dental problems but also to help detect other chronic diseases and improve overall health outcomes. To help maintain good health and wellbeing, our plans will include increased preventative benefits starting 2022:
Give your small business clients a 10% specialty discount! Anytime you add dental and/or vision to a new or existing small business client's medical coverage, a 10% discount will be applied to the dental and/or vision premiums. Learn more.
This means one bill, one renewal, and one point of administration for all of your clients' Blue Shield business. And, your clients can access and manage all of their coverage information through Employer Connection.
A two-year initial rate guarantee applies to both new and existing medical groups adding a dental or vision plan, and/or life insurance.
Members have access to one of the largest dental PPO or dental HMO networks with their dental plans from Blue Shield in California and nationwide. This gives dental PPO members the flexibility to choose from a large number of providers in and out of network, while dental HMO members can maximize their plan's value by accessing dental care at qualified in-network providers.
Blue Shield offers a variety of dental PPO and HMO plans with no waiting periods. Groups can also offer voluntary options to their employees. Our flexible dual and triple options let you offer two or three dental plans.
All DHMO plans include orthodontic coverage for all ages. Our new dental PPO portfolio includes plans with child-only, child and adult, or no orthodontic coverage to help employers find the right plan for their employees. DPPO plans with orthodontic coverage are also offered for all ages with either a $1,000 calendar-year maximum over 24 months or as a lifetime benefit up to the ortho max amount on the plan.
Coverage for Invisalign “invisible” (clear) braces is included in our plans. Members are responsible for any costs over the amount of traditional braces.
Learn more about orthodontia coverage.
All dental PPO plans include an oral cancer screening benefit covered at 100%. Oral cancer can hide below the surface, and detecting it early can greatly improve treatment success.
Pediatric dental benefits are included within our small business medical plans. PPO, HSA, and HMO medical plans and provide the same PPO dental coverage for pediatric dental benefits, but only PPO and HSA medical plans will offer coverage for pediatric dental benefits received from non-network providers, at non-network provider benefit levels. There is no coverage for non-network pediatric dental benefits in our HMO medical plans, except for emergencies. Dental and vision care are required essential health benefits (EHBs) under the Patient Protection and Affordable Care Act of 2010 (ACA) for children up to age 19. Learn more about the importance of pediatric dental care.
A 50% contribution is required for all dental plans∞ except Voluntary Dental plans; no employer contribution required.
|Specialty acronyms||Definition||Additional clarification||Applicable Advantages|
|Member use of In-network providers can help reduce out-of-pocket costs for the member by reimbursing providers at a higher rate for the delivered services.|
Usual, Customary, Reasonable
|Meaning Blue Shield of California will only pay what we consider to be a usual, customary, and reasonable charge for any covered expenses incurred.||UCR plans can help members get maximum out-of-network providers and are good for groups with employees in remote areas.|
Maximum Allowable Charge
|This is a feature that will help our members save on out-of-pocket costs. Claims are paid according to the PPO fee schedule (maximum allowable charge). If a non-PPO provider is used, the member will pay a higher fee.||MAC plans can reduce premiums and are also advantageous when the majority of a group's providers are participating in the insurer's network. Groups that have not had dental coverage before can benefit from a MAC plan because premiums are typically lower.|
No Waiting Period
∞ Voluntary dental plans have a 12-month waiting period for major services. For groups selecting voluntary PPO dental that have prior dental coverage including “major” benefits for 12 months or more, the 12-month waiting period will be waived for all initial enrollees.
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Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.