Northern Virginia Blue Cross Blue Shield Dental insurance Plans for Individuals
- Easy enrollment - No deductibles - Predictable out-of-pocket costs - No claims forms to file - Guaranteed acceptance
Northern Virginia Cities and area that are in the CareFirst Blue Cross Blue Shield Territory :
Lorton, Occoquan, Newington, Burke, Fairfax Station, The City of Fairfax, Annandale, Vieanna, Dunn Lorning, Lake Barcroft, North Springfield, Springfield, Lincolnia, Franconia, Fort Belvoir, Huntley meadows, Hybla Vallry, Fort Hunt, Rose Hill, Bailey's Crossroads, Alexandria, Arlington, McLean, Hooes Road Park, South run, Ox Rd, Groveton, Lee District, Old Town Alexandria, Langley, Arlington Cemetary, Del Ray, Jamestown Park, Glebe Road, Military Rd, Old Dominion, Clarendon, Fort Myer, Crystal City, Pentagon City,
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July 1, 2010 that may impact how much you’ll pay for certain types of dental services.
Based on the passing of Virginia House Bill 1263, beginning on July 1, 2010, Virginia dentists, dental specialists, and oral surgeons will no longer be required to accept the allowed amount (discount) as payment in full for non-preventive and diagnostic services. Examples of these services include fillings, extractions, root canals, crowns, and orthodontics. You should check with your participating dentist to determine whether (s)he will continue to honor the allowed amount (discount) for non-preventive and diagnostic services.
Please note that this legislative change does not impact covered services such as exams, cleanings and x-rays, which will continue to be paid at 100% when you use an in-network provider. For more details about what services are covered, please refer to the booklet you received with your dental identification card, titled “Dental Plan Benefit Information” for your Individual Select Preferred dental plan.
Should you have additional questions, please call Dental Business Operations Member Services at (888) 833-8464 between 8:30 a.m. – 5:00 p.m., Monday through Friday. |
Individual Select Preferred
PPO Dental Plan
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CareFirst BlueCross BlueShield brings you
Individual Select Preferred Dental which offers:
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Individual Select Dental HMO
HMO Dental Plan
The Dental Network brings you the Individual Select Dental HMO Plan which offers: |
Coverage Type |
Annual Rate Full Annual Payment Due with Enrollment Application |
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Individual |
$151.44 |
Individual & Child(ren) |
$280.20 |
Individual & Adult |
$302.88 |
Family |
$424.08 |
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See More Payment Options - Payment Modes |
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Coverage Type |
Annual Rate Full Annual Payment Due with Enrollment Application |
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Individual |
$120.00 |
Individual & Child |
$204.00 |
Individual & Adult |
$240.00 |
Family |
$360.00 |
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See Other Payment Options - Payment Modes
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Benefits at a Glance
- More than 3,400 dentists throughout Maryland, DC
and Northern Virginia
** PLEASENOTE:DuetolegislationeffectiveJuly1,2010,participatingdentistsandoral surgeons do not need to accept CareFirst’s discounts on non-covered services such as fillings, crowns, root canals and orthodontia. This means you may be required to pay your dentist’s entire billed amount for these non-covered services. Please talk with your dentist about your cost for any dental services.
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Dental Service |
Regular Cost of Dental Services* |
Individual Select Preferred You Pay |
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Biannual Checkups (twice a year) including routine exams, cleanings and x-rays |
$225 (2 visits per year) |
No charge in-network |
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Simple Tooth Extractions |
$135 |
$69-$93** |
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Periodontal Scaling and Root Planing (four or more teeth per section of the mouth) |
$210 |
$116-$137** |
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Porcelain Crown (high noble metal) |
$915 |
$575-$680** |
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Complete Upper Dentures |
$1,375 each |
$665-$800** each |
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Orthodontics (braces)
Adolescents
Adults |
$4,890
$5,110 |
$2,900-$4,700**
$2,900-$4,700** |
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* Based on 2006 National Dental Advisory Service Fee Report.
** This portion of the plan is not an insurance product. In-network providers typically charge reduced rates within these ranges. Member charges are based on CareFirst allowances with the participating providers. Since rates vary by provider, members should check with their participating dentist to determine the costs of specific procedures. Members must pay these reduced rates directly to the provider during the office visit.
Please see the brochure for details of the benefits
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Benefits at a Glance
-Lower cost
- More than 800 dentists throughout Maryland, DC
and Northern Virginia |
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Dental Service |
Regular Cost of Dental Services* |
Individual Select Dental HMO You Pay |
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Biannual Checkups (twice a year) including routine exams, cleanings and x-rays |
$225 (2 visits per year) |
$20 per office visit copay |
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Simple Tooth Extractions |
$135 |
$20 per office visit copay |
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Periodontal Scaling and Root Planing (four or more teeth per section of the mouth) |
$210 |
$70 per office visit copay |
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Porcelain Crown (high noble metal) |
$915 |
$460 |
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Complete Upper Dentures |
$1,375 each |
$495 each |
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Orthodontics (braces)
Adolescents
Adults |
$4,890
$5,110 |
$2,500
$2,700 |
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Please see the brochure for details of the benefits
* Based on 2006 National Dental Advisory Service Fee Report.
** This portion of the plan is not an insurance product. In-network providers typically charge reduced rates within these ranges. Member charges are based on CareFirst allowances with the participating providers. Since rates vary by provider, members should check with their participating dentist to determine the costs of specific procedures. Members must pay these reduced rates directly to the provider during the office visit.
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Limitations and Exclusions
3.1 Limitations.
A. Covered Dental Services must be performed by or under the supervision of a Dentist, within the
scope of practice for which licensure or certification has been obtained.
B.Benefits will be limited to standard procedures and will not be provided for personalized
restorations or specialized techniques.
3.2 Exclusions. Benefits will not be provided for:
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Additional fees charged for visits by a Dentist to the Member’s home, to a hospital, to a nursing
home, or for office visits after the Dentist’s standard office hours. CareFirst shall provide the benefits for the dental service as if the visit was rendered in the Dentist’s office during normal office hours.
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Services not specifically listed in this Attachment as a Covered Dental Service, even if Medically Necessary.
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Services or supplies that are related to an excluded service (even if those services or supplies would otherwise be covered services).
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Separate billings for dental care services or supplies furnished by an employee of a Dentist which are normally included in the Dentist’s charges and billed for by them.
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Telephone consultations, failure to keep a scheduled visit, completion of forms, or administrative services.
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Services or supplies that are Experimental or Investigational in nature.
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