Transcript BOR DENTAL Blue Cross and Blue Shield

BOR DENTAL
Blue Cross and Blue Shield
 One Time Enrollment
 Participating Dentists Network
http://www.usg.edu/admin/humex/benefits/dental
National Network
(use of non-network providers will be subject to balance billing)
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
24 month prior enrollment for replacement of
prosthetics
 Crown replacement when necessary after 5 years from
installation
 Surgical extraction of impacted wisdom teeth is not
covered
 6 month prior enrollment for access to orthodontic
See detail exclusions pg. 14 of the BOR Indemnity Dental
Book
BOR PREVENTIVE DENTAL CARE
NO DEDUCTIBLE - PLAN PAYS 100%

FLUORIDE TREATMENT

ORAL EXAMINATIONS

PROPHYLAXIS (Cleaning)

X-RAYS
BOR DENTAL CARE
AFTER $50 DEDUCTIBLE - PLAN PAYS 80%

ANESTHESIA

EXTRACTIONS

FILLINGS

ROOT CANAL TREATMENT

BRIDGES

CROWNS

DENTURES

INLAYS/ONLAYS
BOR ORTHODONTIC CARE
AFTER $50 DEDUCTIBLE - PLAN PAYS 80%
ORTHODONTIC
APPLIANCES & TREATMENT
BOR DENTAL
Blue Cross and Blue Shield
 Lifetime Maximum
($1,000 for orthodontics)
 Claim Form
 Greater Out-of-Pocket Expense
 Calendar Year Maximum ($1,000)
BOR DENTAL
COST PER MONTH
-Single
-Employee/Child
-Employee/Spouse
-Family
$27.24
$51.74
$54.46
$87.14