Groups with 101 or more eligible employees can select any Blue Shield dental plan with or without Blue Shield medical coverage.
The dental PPO network includes over 45,000 provider access points in California, putting Blue Shield’s large DPPO network among the top five in the state. Our national PPO network includes over 380,000* access points. Our dental PPO plans provide employees with a wide range of benefits, including 100% coverage for diagnostic and preventive services from participating network dentists; in-network utilization is nearly 71%.
With our dental HMO network employees can choose from over 4,600 dentists in California at more than 22,000 access points. Our six dental HMO plans complement our dental PPO plan portfolio. Employers can offer dental benefits for basic and major services with no waiting periods, deductibles, or calendar-year maximums. The dental HMO plan portfolio helps simplify dental coverage for your clients by offering lean, middle or rich benefit designs.
All new and renewing groups adding dental receive a two-year rate guarantee# on their dental coverage, giving them added financial predictability for budgeting and planning.
Our improved bundling program now applies to groups of 101 up to 1,000. Your clients can save up to 3% on their medical rate by bundling dental, vision‡, and life insurance‡ with their medical benefits.
Members can get more from select DPPO dental plans with our Diagnostic and Preventive Care waiver program. Diagnostic and preventive claims that would have gone against the calendar-year maximum are waived so employees get more from their plan. This waiver program encourages employees to seek preventive care and address small problems before they become big ones. Learn more.
Dental Smile Rollover Rewards is another benefit with select DPPO plans. Members are rewarded for visiting the dentist at least once a year. As long as the annual paid dental claims are below the claim threshold, the member receives a reward. If members see a dentist in the PPO network versus a non-network dentist, the members receive an additional boost to their rewards amount. The reward amount is based on the dental plan’s calendar-year maximum and the programs annual claims threshold for the plan. Any rewards earned will roll over in the form of calendar-year maximum funds and raise the member’s calendar-year maximum for the benefit year. Learn more.
Our coinsurance amount is 50% with an annual maximum of up to $1,000 or up to a lifetime maximum of $2,000. Orthodontic plans also offer an allowance for Invisalign and clear braces. The member simply pays the difference between the cost of the clear braces and what is paid for traditional orthodontic treatment (braces). Learn more.
Implants are covered as a major service on all dental HMO and PPO plans. Member responsibility varies based on the plan design. Details can be found in the Evidence of Coverage and the copy schedule for each plan. Learn more.
Additional benefits for children to help prevent or treat tooth decay.
All dental HMO and PPO plans include an oral cancer screening benefit covered at 100%. Oral cancer can hide below the surface, and early detection greatly improves success of treatment.
Blue Shield of California eligible plans have virtual visits with licensed dentists.
Dental advice and guidance will be provided for Diagnostic and Preventative benefits.
A virtual visit with a dentist is intended to promote oral hygiene as well as address any dental health concerns, both urgent and non-urgent. The dentist will usually ask a series of diagnostic questions and sometimes request photos or videos to view the mouth. Based on the situation, the dentist may make a diagnosis, suggest treatment options, or recommend a follow-up visit.
Members may use their own dental provider if they have Tele-Dentistry capabilities or they may use any dentist with Tele-Dentistry capabilities. As with any dental services, an in-network provider is recommended.
Periodontal treatment during pregnancy may reduce premature births. That’s why we provide one additional cleaning for pregnant women in all of our PPO and dental HMO plans. A third periodontal maintenance visit is also covered, if needed, to treat periodontal disease.
Members can get easy access to benefit and coverage information, claims payment and status updates, and digital ID cards through blueshieldca.com when they register their account. For on-the-go access, members can download the Blue Shield app on their mobile device.
Help your clients see the value that dental coverage can bring them. Share the infographic, Why You Need Group Dental Coverage.
* Access point(s) refers to all the locations where a member can “access” care. For example, a provider who treats patients at two different office locations represents two access points.
‡ Underwritten by Blue Shield of California Life & Health Insurance Company (Blue Shield Life).
# Periodontal maintenance covered with a documented periodontal condition. Covers one course of periodontal scaling and root planning.
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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.