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  BLUE CROSS BLUE SHIELD
INDIVIDUAL DENTAL



 
Blue Cross  Individual Plans with Dental
The Individual Dental Indemnity plan is available as an optional benefit with your Individual Blue Cross Blue Shield of Texas health insurance plan. There is an additional premium for the Individual Dental Indemnity plan.
Upon enrolling in the plan, members will receive a fulfillment package inclusive of all of the dental procedures covered under the plan. The fee schedule of benefits will identify the maximum allowable benefit members can receive when a procedure is performed. The dollar amount assigned to each procedure is the maximum any member can receive, not to exceed actual charges. A $50 deductible, based on fee schedule allowances, will apply for dental procedures or services received by a covered individual during each benefit year. For family coverage, the maximum deductible amount is $150. Deductible amounts do not apply to such procedures as oral exams, cleaning, fluoride treatments, sealants, and x-rays.
 


 
 
       
Blue Cross Blue Shield Plans® • Blue Cross Blue Shield of Texas Health Insurance • PPO Select Saver
•
PPO Select Value Care • PPO Select Temp • Foundation Hospital Care • BlueEdge Individual HSA •
Blue Cross Individual plans With Dental
•
PPO Select Blue Advantage
• PPO Select Choice

Humana One Plans® • Humana One • Humana One with office Co-Pay • Humana One with office Co-Pay and $0 RX Deductible • Humana One with Dental Plans

Aetna® Individual Health Insurance• Aetna Individual PPO• Aetna Individual PPO with Dental

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Blue Cross Blue Shield® and their products are registered trademarks of Blue Cross Blue Shield of Texas Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
Humana One® and their products are registered trademarks of
Aetna® and their products are registered trademarks of
United Healthcare® and their products are registered trademarks of United Health Group Company
Unicare® and their products are registered trademarks of Wellpoint Health Networks, Inc.

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