Important information for members with individual or family dental plan

DentalBlue Gold, Silver and Bronze Member

Deductibles, Coinsurance and "Roll Overs"

• In most cases, members are responsible for deductibles and coinsurance at the time services are performed.
• If you met your deductible on another dental plan, you cannot receive credit toward this plan’s deductible.
• With DentalBlue Gold, you may "roll over" a portion of your unused maximum benefit to the next year ($350) if you submit at least one claim during the year and your total claims do not exceed $500 for the year.

Dependent Coverage

• Stepchildren are eligible for coverage.
• Single, dependent children are covered to age 26 as long as premiums are paid when due. When a dependent turns age 26, he or she will be enrolled automatically in an individual dental plan of his or her own. A notice will be sent to you and your dependent.

Payment of Premium

• Members have a "grace period" of 31 days to pay a premium after it is due. However, if the payment is not received, the policy will be terminated on the date the premiums were due.
• If your policy does get cancelled due to non-payment of premiums, it may be reinstated within 60 days if the premium is paid (certain rules may apply). To get your policy reinstated and pay your premium, call 800-238-8379.

Waiting Periods

• If you had dental coverage with another insurance company and now you have either our Silver or Gold plans, the waiting period for minor restorative services can be waived if you submit proof of Minor Restorative Creditable Coverage. Your Certificate of Creditable Coverage needs to reflect minor restorative coverage.
• If you have applied for coverage under DentalBlue and your coverage has been in place for at least six months with BlueCare Dental, we will waive the six-month minor restorative waiting period.
• Although you have had prior dental coverage, the waiting period for major restorative services under the Gold plan cannot be waived.

Other Things to Know

• Monthly premiums can automatically be deducted from your bank account. Call 800-238-8379 for more information.
• Orthodontic services are not covered.
• If you visit a nonparticipating dentist and need to have your claim processed, please mail your claim form to:
  Dental Claims Administrator
  P.O. Box 69436
  Harrisburg, PA 17106-9436

BlueCare Dental Members

Deductibles, Coinsurance and "Roll Overs"

• In most cases, members are responsible for deductibles and coinsurance at the time services are performed.
• BlueCare Dental does not allow members to "roll over" any unused benefits for use in the next calendar year.
• If you met your deductible on another dental plan, you cannot receive credit toward this plan’s deductible.

Dependent Coverage

• Stepchildren are eligible for coverage.
• Single, dependent children are covered through age 18 as long as premiums are paid when due. When a dependent turns age 19, he or she will be enrolled automatically in an individual dental plan of his or her own. A notice will be sent to you and your dependent.

Payment of Premium

• Members have a "grace period" of 31 days to pay a premium after it is due. However, if the payment is not received, the policy will be terminated on the date the premiums were due.
• If your policy does get cancelled due to non-payment of premiums, it may be reinstated within 60 days if the premium is paid (certain rules may apply). To get your policy reinstated and pay your premium, call 800-238-8379.

Waiting Periods

• If you had dental coverage with another insurance company, it does not count toward offsetting the waiting periods or deductibles with BlueCare Dental.

Other Things to Know

• New enrollments for this product are no longer being accepted after Jan. 1, 2011. However, new affordable plans are available.
• Orthodontic services are not covered.
• If you visit a nonparticipating dentist and need to have your claim processed, please mail your claim form to:
  Dental Claims Administrator
  P.O. Box 69436
  Harrisburg, PA 17106-9436