There are two PPO options - low and high, the PPO plans allow you to receive benefits from any licensed dentist. Both the standard and the high option has a preferred network, but you may visit a dentist in or out of the network. The provider directory can be viewed at www.bcbsfl.com You, or your dentist, will file a claim form and be reimbursed for services according to a pre-determined percentage basis.
In Network reimbursement
- Preventative Services - 100% of allowed amount (no deductible)
- Oral Exams, Cleanings, Bitewing x-rays
- Basic Services - 85% of allowed amount
- Extractions, Root Canals, Periodontal Scaling, etc.
- Major Services - 55% of allowed amount
- Crowns, Bridges, Dentures, etc.
- In network dentists can not bill more than the allowed amount
- $50 individual/$150 family deductible
Out of Network reimbursement
- Preventative Services - 80% of allowed amount (no deductible)
- Basic Services - 60% of allowed amount
- Major Services - 40% of allowed amount
- Out of network dentists can bill in excess of the allowed amount
- $100 Individual/$300 Family annual deductible
- Plan year maximum - $1,500 per covered person
- Orthodontia benefit - Children to age 19
- 12 month waiting period may apply to orthodontia