Regional Preferred (PPO) Dental

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.

CareFirst BlueCross BlueShield (CareFirst) Regional Preferred (PPO) Dental offers the freedom to select any dentist along with the opportunity to reduce out-of-pocket costs by visiting a Preferred dental provider. This coverage is available with any CareFirst medical plan or as a freestanding plan.

Advantages:

• Regional network of Preferred dental providers throughout Maryland, Virginia, and Washington, D.C.
• A variety of Preferred dental plans to fit members' needs and the company's budget.
• Dental coverage includes:
  • Preventive care such as cleanings and X-rays
    Basic services such as fillings and extractions
  • Major surgical services including oral surgery and root canal therapy
  • Major restorative services including dentures and fixed bridges and crowns
• No claim forms to file when visiting a Preferred dental provider
• Preferred dental providers accept CareFirst's allowed benefit as payment in full for covered services
• Members are only responsible for deductibles and coinsurance when using a Preferred dental provider
• Groups can purchase dental coverage with medical insurance or as a freestanding policy
• Nationwide emergency coverage

Additional Features:

• Orthodontia coverage - An optional orthodontia benefit is available for groups with two or more employees
• Out-of-network care - Members have the option of seeing any dentist and still receive coverage. However, they may have to file their own claim forms and pay higher out-of-pocket costs

How To Access Care:

1. When Using Preferred Dental Providers:
   1. Members can locate a Preferred dental provider by reviewing the Find a Doctor section of www.carefirst.com, or referring to their printed directory.
   2. The member ID card is shown to a Preferred dental provider at time of service.
   3. There are no claim forms to file and no balance billing; members are only responsible for the deductible and coinsurance.
      
      
2. For Non-Preferred Dental Providers:
   1. If members visit a dentist who participates with CareFirst, but not the Preferred Dental Network, they may be subject to higher out-of-pocket costs. However, they will not need to file their own claim form and they will not be balance billed.
   2. If members visit a dentist who does not participate with any CareFirst dental network, they may be subject to higher out-of-pocket costs and be balance billed up to the provider's charges. They will also need to file their own claim forms