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DENTAL
Regular visits to your dentist can protect more than your smile; they can help protect your health.
The HydraFacial Company provides you with two comprehensive dental options through Anthem
Blue Cross: Dental Net HMO (available in California only) and Dental Complete PPO.
Key Benefits
Dental Net HMO (CA Only)
Dental Complete PPO
In-Network
In-Network
Out-of-Network
Plan Year Deductible
Individual
Family
None
None
$50
$150
$50
$150
Plan Year Maximum
None
$1,000
$1,000
Waiting Period
None
None
None
Diagnostic and Preventive
$0 - $60 copay
100%
100%
Basic Services
Fillings
$0 - $55
100%
80%
Root Canals
$70 - $140 copay
100%
80%
Periodontics
$0 - $115 copay
100%
80%
Major Services
Crowns
Dentures
Oral Surgery
$5 - $170 copay
$0 - $315 copay
$0 - $350 copay
60%
60%
60%
50%
50%
50%
Orthodontic Services
Lifetime Maximum
Unlimited
$1,000
$1,000
Dependent Children up to age 19
$1,695 copay
50%
50%
Adults
$1,895 copay
Not Covered
Not Covered
M A X I M U M R O L L O V E R
•
Your annual max and max rollover will
transfer from your prior dental carrier for the
remainder of the year in addition to fresh
calendar year deductible and maximums for
10/1/2017 to 12/31/2017
•
Rollover dollars will be in addition to your
annual max up to $1,000
•
To qualify for the maximum rollover account
in a given year, you must submit at least one
claim during the calendar year, such as
exam or cleaning
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