Dental Health Maintenance Organization (DHMO)

Note: The information below briefly describes important features about this health care program. It is not a contract. A detailed description of benefits is included in the Evidence of Coverage. Please refer to the Evidence of Coverage for specific terms, conditions, limitations and exclusions.

Dental Health Maintenance Organization (DHMO) offers preventive and corrective dental care, including orthodontia coverage, at predictable costs. This DHMO plan is administered by The Dental Network, Inc. (TDN), an independent licensee of the Blue Cross and Blue Shield Association.

Advantages:

• Regional network of dental providers throughout Maryland, Virginia and Washington, D.C.
• Dental coverage includes:
  • Preventive care including cleanings and X-rays
  • Basic services including fillings and extractions
  • Major surgical services including oral surgery and root canal therapy
  • Major restorative services including dentures and fixed bridges and crowns
  • Orthodontia coverage for children and adults
• Copays cover all in-network dental services
• Some plan designs include one copay for office visit for basic dental services such as exams, X-rays and simple extractions
• No claim forms to file when visiting a network dental provider

Additionally, employers may have chosen a plan that offers opt-out benefits.

How to Use Benefits:

1. Locate and select a TDN primary care dentist:
   • Online:
     • Select Dental - BlueChoice TDN
     • Select "Considering becoming a member"
     • Selecte the appropriate product.
     • Choose a dental provider.
   • By Telephone:
     • Call TDN customer service at 888-833-8464 with selection.
2. At the time of service, show member ID card.
3. Pay the copay for services received.
4. The dentist will submit all the necessary forms.