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DentalEssentials

Unfortunately, the cost of dental treatment, coupled with the lack of dental insurance, sometimes prevents Americans from getting the care they need. Now, with DentalEssentials from Blue Cross and Blue Shield of Nebraska, you can get valuable dental care benefits at the cost that is affordable and accessible with the Blue Cross and Blue Shield network of providers.

 

Option 1

Option 2

Option 3

Option 4

Monthly Premium
(individual)
$41.26 $28.68 $47.45 $32.98
Deductible $50
per person
per calendar year
$50
per person
per calendar year
$50
per person
per calendar year
$50
per person
per calendar year
Annual Benefit Maximum $1,000
per person
per calendar year
$1,000
per person
per calendar year
$1,000
per person
per calendar year
$1,000
per person
per calendar year
Coinsurance In-Network Out of Network In-Network Out of Network In-Network Out of Network In-Network Out of Network
Coverage A Services 0%
(deductible waived in-network)
20% 0%
(deductible waived in-network)
20% 0%
(deductible waived)
0%
(deductible waived)
Coverage B Services
(6 Month Waiting Period*)
20% 30% 20% 30% 20% 20%
Coverage C Services
(12 Month Waiting Period)
50% 50% N/A N/A 50% N/A
* Waived for seniors purchasing a Medicare Supplement plan at the same time as a DentalEssentials plan.

Coverage A Benefits

Preventive and Diagnostic Dentistry

Two comprehensive and/or periodic oral examinations per calendar year
  • Consultations with a dental consultant
  • Two prophylaxis, including cleaning, scaling and polishing of teeth per calendar year
  • Dental x-rays**
    • One full mouth or panorex series of x-rays in any period of three consecutive calendar years
    • One set of four supplemental bitewing x-rays in a calendar year
** X-rays related to services provided under a different coverage classification are excluded under Coverage A benefits

 

Coverage B Benefits

Maintenance and Simple Restorative Dentistry and Oral Surgery

Oral surgery consisting of:
  • Simple and impacted extractions (extractions for orthodontia services are excluded)
  • Removal of dental cysts and tumors
Other services:
  • General anesthesia
  • Restorations of silver and/or composite materials
  • Palliative treatment
  • Problem focused and/or emergency oral examinations

 

Coverage C Benefits***

Complex Restorative Dentistry, Periodontic and Endodontics

Coverage C services:
  • Crowns
  • Installation of permanent bridges
  • Dentures – full and partial
  • Denture adjustments
  • Repair of dentures, bridges, crowns and cast restorations
  • Core buildup
Periodontic services consisting of:
  • Up to four periodontic cleanings per calendar year
  • Gingivectomy
  • Gingival curettage
  • Osseous surgery
  • Treatment of acute infection and oral lesions
Endodontic services consisting of:
  • Pulp cap
  • Vital pulpotomy
  • Root canals (includes treatment plan, clinical procedures and follow-up care)
  • Apical curettage
***Benefits for Coverage C services are subject to a 12-month waiting period.

 

This is a brief description of DentalEssentials coverage. A more complete list can be found in the DentalEssentials contract. For information about limitations and non-covered services, view the DentalEssentals information brochure below.

DentalEssentials Information Brochure [pdf]