BlueCare Dental PPO^SM

The BlueCare Dental PPO^SM product is a product available for purchase on a self-funded basis only. The PPO dental plan provides a higher level of benefits when members receive treatment from BlueCare Dental participating providers.

With BlueCare Dental PPO, members have the option to receive care from dentists who are not in the network. However, the lower benefit plan level will apply and out-of-pocket expenses will be higher when receiving dental services from dentists not in the BlueCare Dental^SM network. Non-contracting dentists will charge employees their regular fee and may bill them for the balance not covered by the dental benefit plan. Additionally, members may have to submit claims for reimbursement.

If the member elects to receive care from BlueCare Dental network providers:

They will receive the higher level of benefits (In-Network Benefits)
They are not required to file claim forms – Network providers bill BCBSTX for services provided
They are not balance billed -- Network providers will not bill for costs that are in excess of the BCBSTX allowable amount for covered services.

If the member elects to receive care from providers outside of the network, they may choose:

DentaBlue ^SM Dentists Providers participating in a direct-payment arrangement with BCBSTX	Out-of-Network Dentists Non-contracting providers
If the member elects to receive care from a DentaBlue Dentist, benefits for covered services are available at the lower level of benefits (Out-of-Network); however… DentaBlue Dentists will file the member's claim forms DentaBlue Dentists will not bill the member for costs exceeding the BCBSTX allowable amount for covered services	If the member elects to receive care from a non-contracting provider, benefits for covered services are available at the lower level of benefits (Out-of-Network); and… Members will be required to file their own claim forms Members will be responsible for amounts in excess of the BCBSTX allowable amount for non-contracting providers --- which may be considerable

DentaBlue ^SM Dentists
Providers participating in a direct-payment arrangement with
BCBSTX

Out-of-Network Dentists
Non-contracting providers

If the member elects to receive care from a DentaBlue Dentist, benefits for covered services are available at the lower level of benefits (Out-of-Network); however…

DentaBlue Dentists will file the member's claim forms
DentaBlue Dentists will not bill the member for costs exceeding the BCBSTX allowable amount for covered services

If the member elects to receive care from a non-contracting provider, benefits for covered services are available at the lower level of benefits (Out-of-Network);
and…

Members will be required to file their own claim forms
Members will be responsible for amounts in excess of the BCBSTX allowable amount for non-contracting providers --- which may be considerable

In addition, members have access to the BlueCare Dental Connection program. The program integrates dental care management and health care management with a focus on preventive care and individual involvement. This program provides members with education and intervention through support tools and educational mailings. Access the Dental Wellness Center .

For more detailed information on the plan designs available, covered benefits, services and supplies that are limited or excluded, general administration of the plan, or any other questions you may have regarding our products and services, please contact us for the phone number of the regional sales office near you.

[Top of Page]

BlueCare Dental PPOSM

BlueCare Dental PPO^SM