Information for members with individual or family dental plan

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 Gold or Gold Plus Vision, 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.

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 premium was due.
• For members who enrolled through the Health Insurance Marketplace and applied a portion of their Advance Premium Tax Credits (APTC) toward the payment of their premium, a grace period of three consecutive months will be granted for the payment of premiums after receipt of the first month’s premium.
• If your policy cancels for non-payment of premium, 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 1-800-238-8379. (Reinstatement policy does not apply to policies purchased through the Health Insurance Marketplace.)

Waiting Periods

• Pediatric Minor and Major Restorative Services are not subject to waiting periods.
• Adult members enrolled in Dental Silver will have the 6-month waiting period for Minor Restorative services. The waiting period will be waived if the follow criteria is met:
  • The application is received within 30 days of the termination date of the member’s previous coverage; and
  • No later than 30 days from the effective date of the new policy with Arkansas Blue Cross and Blue Shield, the member provides us with:
    • A copy of the member’s previous dental policy Certificate of Coverage which reflects the policy's effective and termination dates; and
    • A copy of the member’s previous policy's benefit schedule which reflects at least six months of coverage for Minor Restorative services.
• Members enrolled in Dental Gold or Gold Plus Vision will have the 6-month waiting period for Minor and Major Restorative services waived if the follow criteria is met:
  • The application is received within 30 days of the termination date of the member’s previous coverage; and
  • No later than 30 days from the effective date of the new policy with Arkansas Blue Cross and Blue Shield, the member provides us with:
    • A copy of the member’s previous dental policy Certificate of Coverage which reflects the policy's effective and termination dates; and
    • A copy of the member’s previous policy's benefit schedule which reflects at least six months of coverage for Minor and/or Major Restorative services.

Byte® clear teeth aligners

Get the smile you’ve always wanted without breaking the bank when you take advantage of special discount rates available for Byte® at-home clear aligner treatment for teeth straightening. Byte clear aligners are custom-made and feature a unique treatment plan prescribed by licensed dentists. To learn more visit Byte.

Other Things to Know

• Monthly premiums can automatically be deducted from your bank account. Call 1-800-238-8379 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