Your plan for better healthSM1
Search
Dental Blue

Frequently Asked Questions


General Product Info

Benefits & Coverage

Providers

Claims

Out-of-Pocket Expenses



General Product Info    top

Q: When does my Dental Blue for Individuals coverage begin?

Your coverage can begin on the 1st or 15th of the month. If your application is received by the 8th of the month, your coverage can begin as soon as the 15th of that same month. If your application is received by the 22nd of the month, your coverage can begin as soon as the 1st of the following month. For example, coverage for an application received May 8th can begin as soon as May 15th, coverage for an application received May 22nd can begin as soon as June 1. Requested effective dates may not exceed 60 days from the date you submit your application.

Q: Who is eligible for Dental Blue for Individuals?

You are eligible for dental coverage if you and your dependents (spouses or unmarried dependent children under the age of 26) are residents of North Carolina. A child who is a North Carolina resident may have an individual policy in their name, if necessary. A person is ineligible for coverage if they have had a Dental Blue for Individuals policy within the last 12 months.

Q: Can I change who is covered on the policy?

You may apply to cover your eligible dependents under your policy at the time of initial enrollment. If you do not enroll all eligible dependents at the time of your initial enrollment of coverage, you cannot enroll them later unless there is a family status change such as marriage, divorce, the birth of a child or adoption.

Q: What kind of changes can I make to my policy online?

  • Change physical and/or billing address
  • Change your billing method
  • Change name
  • Change email address, phone number, and contact preferences
  • Remove dependents

Q: If I cancel my Dental Blue for Individuals coverage, how soon may I reapply?

If you choose to cancel your Dental Blue for Individuals coverage or it is terminated for any reason, you may not reapply for 12 months from your termination date.

Q: Are my monthly premiums subject to change?

You may experience a change in your monthly premiums at the time of your annual renewal, which is January 1 of each year, or when you add or remove dependents.


Benefits & Coverage    top

Q: What is the waiting period for Dental Blue for Individuals and how does it apply to me?

A waiting period is the time from your effective date to the day you can receive benefits for covered dental service. With Dental Blue for Individuals, the waiting period is 6 months for Basic services and 12 months for Major services. Refer to your benefit booklet for a listing of Basic and Major dental services.

NOTE: There are no waiting periods for preventive and diagnostic services.

Q: Is orthodontic care covered?

No. Dental Blue for Individuals does not provide coverage for orthodontic care.

Q: What is included in Diagnostic and Preventive services?

Diagnostic and Preventive services include routine oral exams, cleanings, X-rays, fluoride treatments, pulp testing, and sealants. Members are encouraged to take advantage of these services, which are covered at 100 percent of the allowable charge, in order to prevent more serious dental problems later.

Q: Is there an annual limit to coverage?

Yes, This benefit allows $1,000 of covered services each benefit period. Any thing above that $1,000 will be the responsibility of the patient to pay.

Q: What is included in Basic Services?

Routine fillings
Space maintainers (members under 16 years old)
Endodontics
Simple extractions
Stainless Steel Crowns
Oral surgery
Other basic services

Q: What is included in Major Services?

Gingival curettage
Gingivectomy and gingivoplasty
Periodontal maintenance
Inlays and onlays (once per 5 years)
Porcelain Crowns
Dentures
Bridges
Other major services


Providers    top

Q: Do I have to choose a dentist in Blue Cross and Blue Shield of North Carolina's (BCBSNC) dental network?

No. Dental Blue for Individuals gives you the freedom to see any licensed dentist you wish. However, you will save on your out-of-pocket dental expenses if you use a participating dental provider. These providers are credentialed and approved by BCBSNC.

Q: Why should I receive my dental care from a participating network provider?

When you receive covered services from a participating dental provider, you are not responsible for any charges over the allowed amount, which means you can save on your out-of-pocket expenses for dental services.

Q: How do I know if my dental provider is participating in your dental network?

You can access the directory of participating dental providers by visiting our Web site at www.bcbsnc.com/memberservices/public/dental/.


Claims    top

Q: How do I file a dental claim?

Unless your dentist accepts assignment of benefits and files on your behalf, you should pay the dentist in full and submit your claim to BCBSNC so that you can be reimbursed. Complete a dental claim form and mail it to us within 180 days from the date of your service. Send the completed claim form to:

Blue Cross and Blue Shield of North Carolina
Dental Claims Unit
P.O. Box 2100
Winston-Salem, NC 27102-2100


Out-of-Pocket Expenses    top

Q: What dental services are subject to my deductible?

Your $75 deductible applies to Basic and Major dental services. After this deductible is met, BCBSNC will pay 60 percent of Basic and 50 percent of Major services based of the allowable charge, up to your benefit period maximum of $1,000. Each covered dependent under your policy has a $75 deductible to meet for Basic and Major dental services.





Apply Online

Four easy steps to coverage

Free Rate Quote

If you have already started an application, return to it here.

Resume Application

Member Health PartnershipsSM1

Our health management program can help you embrace a healthier lifestyle and can be customized to address specific conditions such as asthma, diabetes and weight loss.