Dental
Dental coverage helps you maintain a healthy smile with preventive care, basic services, and major procedures. You can visit any licensed dentist, but you’ll save the most when you use an in-network provider who has agreed to discounted rates. Out-of-network dentists may charge more than the plan’s allowed amount, and you may be responsible for the difference. Most plans cover preventive services—such as exams, cleanings, and X-rays—at 100% when you stay in-network, making regular checkups an easy way to protect your oral health and avoid costly issues.
Note: If you enroll in medical/Rx and dental coverage through Capital Blue Cross, you will receive one ID card that includes both coverages, rather than separate cards.
Scan the QR code to download the app and set up your account. Go to CapBlueCross.com/finder, you can switch between medical and dental in-network providers by zip code to help you find in-network providers, facilities, services, and more.
You always pay the deductible and copayment ($). The coinsurance (%) shows what you pay after the deductible.
Transition of Care to Capital Blue Cross Dental
When a member’s dental coverage transfers to Capital Blue Cross Dental from another carrier, the following rules apply to services already in progress:
Dental Treatments
Dental treatment in progress when your coverage begins with Capital Blue Cross Dental, such as root canals, crowns, and bridgework, is generally the responsibility of your former dental carrier and is not covered by Capital Blue Cross Dental. Capital Blue Cross Dental will cover treatments started and completed after your Capital Blue Cross Dental plan’s effective date of coverage.
Orthodontic Treatments
If your dependent child is in the midst of an orthodontic treatment when you join Capital Blue Cross Dental, any payments/reimbursements made by a previous dental carrier will be applied to your child’s orthodontic lifetime maximum under the Capital Blue Cross Dental plan.
Core Plan
Benefit Highlights
In-Network
Deductible (Individual/Family)
$50/$150
Annual Plan Max (Per Individual)
$1,500
Preventive Care
50%
Basic Services
50%*
Major Procedures
50%*
Orthodontia (for children up to age 19)
50% coinsurance up to a lifetime maximum of $500
* After deductible (deductible does not apply toward the plan year maximum)
Out-of-Network
Deductible (Individual/Family)
$50/$150
Annual Plan Max (Per Individual)
$1,500
Preventive Care
50%†
Basic Services
50%*†
Major Procedures
50%*†
Orthodontia (for children up to age 19)
50% coinsurance up to a lifetime maximum of $500
† Balance billing may apply
Weekly Plan Cost
Associate Only: $2.89
Associate + 1: $6.18
Family: $9.53
Buy-Up Plan
Benefit Highlights
In-Network
Deductible (Individual/Family)
$50/$150
Annual Plan Max (Per Individual)
$2,000
Preventive Care
$0
Basic Services
20%*
Major Procedures
50%*
Orthodontia (for children up to age 19)
50% up to a lifetime maximum of $500
* After deductible (deductible does not apply toward the plan year maximum)
Out-of-Network
Deductible (Individual/Family)
$50/$150
Annual Plan Max (Per Individual)
$2,000
Preventive Care
$0†
Basic Services
20%*†
Major Procedures
50%*†
Orthodontia (for children up to age 19)
50% up to a lifetime maximum of $500
† Balance billing may apply
Weekly Plan Cost
Associate Only: $5.05
Associate + 1: $10.80
Family: $16.64
Example: How the Buy-Up Plan Pays Benefits
In both the Core and Buy-Up Plans, when you see in-network PPO Preferred dentists, you pay your share of the cost, up to the plan allowance. But with out-of-network dentists, you pay your share of the plan allowance plus any amounts the dentist charges above the plan allowance. That’s why you save more with in-network dentists.
Here’s an example of how the Buy-Up Plan pays benefits if you get a filling.
| PPO In-Network Dentist | Out-of-Network Dentist | |
|---|---|---|
| Dentist charge | $90 | $90 |
| Plan allowance | $70 | $72 |
| Your coinsurance | 20% coinsurance after deductible | 20% coinsurance after deductible |
| Capital Blue Cross payment | $56 | $57.60 |
| You pay | $14 | $32.40 |
| Explanation of what you pay | 20% of the $70 plan allowance | 20% of the $72 plan allowance ($14.40) plus the charges above the plan allowance ($90 − $72 = $18) |
The above example is for illustrative purposes only and assumes the annual deductible has been met.
DHMO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
None
Annual Plan Max (Per Individual)
Unlimited
Preventive Care
$0
Basic Services
You pay scheduled amount
Major Procedures
You pay scheduled amount
Orthodontia (for children up to age 19)
You pay scheduled amount
Weekly Plan Cost
Associate Only: $2.91
Associate + 1: $5.64
Family: $8.06
Dental Health Maintenance Organization (DHMO) via Capital Blue Cross Dental Select
The DHMO operates differently than the Core or Buy-Up Plans. The DHMO’s Select network is smaller but participating dentists have agreed to preset copayments — dollar amounts that are listed in the schedule of benefits — so you know the price of the service before you go. There are no deductibles or maximums, adult and child orthodontia is covered, and you don’t file claims. Note there is no out-of-network coverage. You choose a primary dentist, who must coordinate any referrals if you need a specialist.
Before you enroll, be sure to look for and choose a dentist in the Select network at capbluecross.com or 1-800-613-2624. Also, see the DHMO Benefits Schedule on MyWeisBenefits.com. At lower right, under “Full-time Associates,” click on “Resource Library.”
capbluecross.com
Set up your Capital Blue Cross account and download the app — register here:
