You are leaving this website/app (site). 0000047395 00000 n A contract provision, included in all standard provider contracts, that allows either the MCO (managed care organization) or the provider to terminate the contract when the other party does not live up to its contractual obligations. The practice of an insurance company underwriting a number of small groups as if they constituted one large group. We provide health insurance in Michigan. HTF>QP13V2Y!QLS=k *Bl~DF*iU&!Tg))a,py7!-p{&1 !$=^S2`;bFp: v}-+OJ9bx0%M{ih,,D-O4oF$>N-fbh gj]N^|w&r~XF#81e{Ta33=gKI. 0000005663 00000 n Log in and look. 2 0 obj <>/Metadata 7 0 R/Names 8 0 R/OpenAction 6129 0 R/Outlines 6130 0 R/PageLayout/OneColumn/PageMode/UseOutlines/Pages 838 0 R/StructTreeRoot 2595 0 R/Type/Catalog/ViewerPreferences<>>> endobj 3 0 obj <>/Font<>>>/Fields[]>> endobj 7 0 obj <>stream =%V|'55KkW|_N&W4to;6ydLHO9;, mZ7mqDe"^=M'K#qFNHMDVx,>:'e ;>7o)rl-aX9]*E@l;Pz{XnGAc[=l V p\Z#'3WIHm"qq&.Sw76c\}oSm+qrA[Eg>95?Zqe"2//bZ^2OT FI"bT$.q+ Rz?>tFZm^-S~t;.3&lL5fFf$=u|A8P3*XK2Ex`Kd5.-Wy?N/e>622H#/r=$Ct^;lcEK v-wsmRT3X"/\{ D See the chart on the back for more plan details. 1. Teeth cleaning (prophylaxis) We provide health insurance in Michigan. Preventive care programs designed to determine if a health condition is present even if a member has not experienced symptoms of the problem. 'on[/b,k"=|g/my6Johp!?yuv9R`LZM8eW$@'I#Z%%@CX2`A6*a)TtAMb?|,*+9 ?B%UFV)l)ypvwIH rtB!gvdPW;R13LmVDwfeLki]CxEb5n>OT|~_Yz[pw\;Oh1O70A|S|S? 2020-09-09T21:17:19-07:00 BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. Which is the best romantic novel by an Indian author? 0000072686 00000 n 0000139675 00000 n The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. Basic services like fillings and root canals. For travellers, the app is the fastest way to buy and manage Canada's most trusted brand in travel insurance. BlueCare Dental ConnectionSM is a program benefit that provides members with education and intervention through support tools and educational mailings. 0000014199 00000 n WalkingWorks is a physical fitness and wellness program developed by Blue Cross Blue Shield, in cooperation with the Presidents Council of Physical Fitness and Sports, to help BCBS members reach fitness goals while improving your overall health. Blue Cross Blue Shield awards this designation to medical facilities that have demonstrated expertise in delivering quality healthcare in the areas of: bariatric surgery, cardiac care, complex and rare cancers, spine surgery, transplants and knee and hip replacement. 0000000016 00000 n Dental PPO can be purchased as a stand-alone dental product or in conjunction with dental HMO. 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 DentalSM network. 0000004772 00000 n You start paying coinsurance after youve met your plans deductible. We have several tools and resources available to help you make informed decisions about your plan and make the most of your BCBS FEP Dental coverage. 0000041318 00000 n 0000041910 00000 n External link You are leaving this website/app (site). 0000069906 00000 n 0000011502 00000 n There is no waiting period for Class I services. Class IV services are not covered. Also known as a medical-necessity review. 0000016797 00000 n A private medical expense insurance policy that provides reimbursement for out-of-pocket expenses, such as deductibles and coinsurance payments, or benefits for some medical expenses specifically excluded from Medicare coverage. In Texas, Medicaid is the program that will offer the most comprehensive dental coverage, especially for children (anyone under 21). Dollar amounts set by MCOs (managed care organizations) that limit the amount a member has to pay out of his/her own pocket for particular healthcare services during a particular time period. Scroll. Box 986030, Boston, MA 02298. It is focused on preventive care and the treatment of routine injuries and illnesses. A provision in a member's coverage that limits the amount of coverage by the plan to a certain percentage, commonly 80 percent. 0000045512 00000 n A coordinated system of preventive, diagnostic and therapeutic measures intended to provide cost-effective, quality healthcare for a patient population who have or are at risk for a specific chronic illness or medical condition. 0000000016 00000 n But you'll pay less if you see a Tier 1 PPOin-network dentist. Bridges and dentures Plus, it can help them manage their out-of-pocket costs. 00421 Most PDF readers are a free download. Information that relates to an individual's past, present, or future physical or mental health or condition, or the past, present, or future payment for the provision of health care to an individual, including demographic information, received from or on behalf of a health care provider, health plan, clearinghouse, or employer, which either identifies the individual or could be reasonably used to identify the individual. t@^@#"Z|2]>q/CS"f 24Dg:y2 Limited to once every 24 months for primary teeth, and once every 48 months for permanent teeth. Free aids and services for people with disabilities to communicate effectively with us, such as: Written information in other formats (such as accessible electronic formats). Includes coordination of benefits, Workers' Compensation, subrogation and no-fault auto insurance. Note: There will be no changes to coverage and claims details for existing Blue Choice plan holders following the new Health and Dental launch on . 0000059102 00000 n This new site may be offered by a vendor or an independent third party. A value-added discount program that provides Blue Cross and Blue Shield members with discounts and content on health and wellness, family care, financial services and healthy travel . PII, as used in these Inter-Plan Programs Policies and Provisions, may have other meanings as assigned by various state laws related to data security breach notification. A medical care center that provides a wide range of healthcare services, including preventive care, acute care, surgery and outpatient care, in a centralized facility. Although the size limit of each MCO (managed care organization) may vary, a small group generally refers to a group containing at least two and less than a hundred members for which health coverage is provided by the group sponsor. Does Blue Cross and blue shield of Texas (bcbstx) have a dental Wellness Center? An agreement with a provider not to bill the subscriber for any difference between billed charges for covered services (excluding coinsurance) and the amount the provider has contractually agreed with a Blue Cross Blue Shield company as full payment for those services. 0000035717 00000 n Call Dentaquest at 1-800-516-0165,MCNA Dental at 1-800-494-6262or UnitedHealthcare Dental at 1-800-822-5353. All Rights Reserved. In the United States, Puerto Rico and U.S. Virgin Islands. The evaluation of health questionnaires submitted by all proposed plan members to determine the overall insurability of the group. A doctor, hospital or other healthcare entity enrolled in a network of designated PPO providers. All Rights Reserved. If the member elects to receive care from BlueCare Dental network providers: If the member elects to receive care from providers outside of the network, they may choose: In addition, members have access to the BlueCare Dental ConnectionSMprogram. The BlueCare Dental PPO product is a product available for purchase on a self-funded basis only. PPO. You may also ask us for a coverage determination by phone at 1-888-285-2249 (TTY:711), We are open 8 a.m. - 8 p.m., local time, 7 days a week. 2021 SUMMARY OF BENEFITS The Dental Schedule of Coverage specifies benefits for: Comprehensive Dental Benefits Children can get pediatric benefits until the end of the calendar year in which they turn 19. Our BlueCare DentalSM program offers two network-based dental products. (Coverage is not available for non-network dentists in Massachusetts except for covered emergency services.) Choose from a variety of affordable group health plans to fit the needs of your employees and your business. 15 49 Bridges and dentures 1-800-267-8221. 0000039957 00000 n 0000006903 00000 n All Canada. Access educational information on a wide range of dental topics including pediatric care, prevention and dental treatments. HealthEquity has . State and Federal Privacy laws prohibit unauthorized access to Member's private information. Most PDF readers are a free download. Cleanings are covered twice a year. Limited to once every 24 months for primary teeth, and once every 48 months for permanent teeth. Healthcare services that are generally considered outside standard medical-surgical services because of the specialized knowledge required for service delivery and management. For all of your dental questions and/or claim forms, please contact your local Blue Cross Blue Shield company. A national program that offers members traveling or living outside of their Blue Cross Blue Shield Plan's area the PPO (preferred provider organization) level of benefits when they obtain services from a physician or hospital designated as a PPO provider. 0000049726 00000 n You can buy this plan if you live in any Michigan county. The content on the Dental Wellness Center website is provided by go2dental.com. In the context of a pharmacy benefit management (PBM) plan, a program that requires physicians to obtain certification of medical necessity prior to drug dispensing. A federal law that outlines the requirements that employer-sponsored group insurance plans, insurance companies and managed care organizations must satisfy in order to provide health insurance coverage to individuals and groups. BlueCard links participating healthcare providers and the independent Blue Cross Blue Shield companies across the country through a single electronic network for claims processing and reimbursement . Patients and members can also call Yavapai Regional Medical Center at 702-616-5789 for assistance or questions. 0000006015 00000 n HUKo@WoR",8iiz5f. A type of Health Benefit Plan that allows members to go outside the network for non-emergency care, but may result in a lower level of benefits being paid by the Health Benefit Plan. Is your health coverage changing. An organization that provides dental care to its members through a network of dentists who offer discounted fees to the plan members. 0000046543 00000 n The examples are meant to help you understand what you might pay, and compare that to other plans. To view this file, you may need to install a PDF reader program. 0000009079 00000 n For dental care, you can go to any licensed dentist and this plan will share the cost. The process of obtaining all the information necessary to determine the appropriate amount to pay on a given claim. BlueCard applies if the provider of service is outside the member's Blue Cross Blue Shield Plan's service area and does not contract with the member's Plan. 0000024004 00000 n 0000012877 00000 n If you're considering enrolling in one of our individual and family plans, learn a bit more about the coverage you'll receive. There is a deductible for Class II and III services only. With the Premium plan preventive care is free and after 6 months the co-payment for fillings and simple extractions is just 20%. 0000107561 00000 n trailer <<52597CAB61384F8F8DEED1C6F907D3A3>]/Prev 159881>> startxref 0 %%EOF 63 0 obj <>stream 0000005163 00000 n Your employer should be able to provide a benefit booklet for you which will provide some details of your coverage. Anthem's medical plans offer healthcare coverage you and your family can rely on. A national data capability derived from Blue Cross Blue Shield companies' collective provider networks and membership. 0000004371 00000 n There is no waiting period for pediatric dental. 0000029289 00000 n Also known as a computer-based patient record. For dental care, you can go to any licensed dentist and this plan will share the cost. These services are covered six months after you first join a Blue Dental plan. A summary of benefits and coverage explains things like what a health insurance plan covers, what it doesn't cover, and what your share of costs will be. This all-ages dental plan covers 100 percent of preventive services like exams and cleanings when you see a Tier 1 PPO in-network dentist, and also helps cover care when you see a dentist who isnt in our preferred network. Defining TMJ for insurance purposes TMJ has a broad definition. Programs designed to educate and motivate members to prevent illness and injury and to promote good health through lifestyle choices, such as smoking cessation and dietary changes. To learn more about dental benefits for STAR children, see the STAR Member Handbook. Keep in mind they aren't based on actual prices. Copyright 2022Health Care Service Corporation. Get access to your agent portal.Register Now. and Prevention (CDC), and state and local public health departments. benefits, keeping your smile healthy and protecting your overall health. In addition, some sites may require you to agree to their terms of use and privacy policy. a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Call us at 800-531-4456 or contact an independent, authorized Blue Cross and Blue Shield of Texas agent. BlueCare Dental ConnectionSM is a program benefit that provides members with education and intervention through support tools and educational mailings. DentaQuest can help members find in-network providers and get authorizations for dental services. An information system that incorporates membership data and provider reimbursement arrangements and analyzes transactions according to contract rules. The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. A review program that evaluates whether drugs are being used safely, effectively and appropriately. This new site may be offered by a vendor or an independent third party. 0000002422 00000 n All member-submitted claims must be received within two years of the date of service. This new site may be offered by a vendor or an independent third party. The designation is based on evidence-based, objective selection criteria established with input from expert physicians and recommendations from medical organizations . Get access to your member portal. After reaching that limit for the year, you pay for 100% of your dental care. Learn more about dental services for adult STAR members, 8 a.m. to 5 p.m. Central Time Monday through Friday. The focus is simple: offer employers multiple dental plan designs that allow greater flexibility to choose a design that best suits their needs at a reasonable price. 0000107951 00000 n application/pdf 0000012040 00000 n Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. 0000063121 00000 n A set of specialized healthcare services that provide support to terminally ill patients and their families. Get access to your provider portal. 0000005327 00000 n 0000001876 00000 n Limitations and Exclusions Exclusions Call Dentaquest at 1-800-516-0165, MCNA Dental at 1-800-494-6262 or UnitedHealthcare Dental at 1-800-822-5353. A group of healthcare providers that agrees to deliver coordinated care, meeting performance benchmarks for quality and affordability in order to manage the total cost of care for their member populations. Matthew Vannatta, Arkansas Blue Cross and Blue Shield Vice President of Consumer and Retail Markets talks to Nichole about changes to health coverages post-pandemic and how BCBS might be able to help. The group must also offer an alternate dental option to HMO. If you are a BCBSIL member and have questions about your health care plan benefits, check with your group benefits administrator or contact Customer Service at the number listed on your BCBSIL member ID card. Overview Adult Dental Pediatric Dental Overview About this plan Thats why Blue Cross and Blue Shield of Texas created BlueCare Dental Connection.

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