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DENTAL
Regular visits to your dentist can protect more than your smile; they can help protect your health.
Recent studies have linked gum disease to damage elsewhere in the body and dentists are able to
screen for oral symptoms of many other diseases including cancer, diabetes, and heart disease.
The HydraFacial Company provides you with two comprehensive dental options through Anthem
Blue Cross: the Dental Net HMO (available in California only) and the Dental Complete PPO.
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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