North Carolina Dental Blue^® NC FAQ

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1. When does my Dental Blue® coverage begin?

A: If your application is received on or before the 20th of the month, your coverage will be effective on the first day of the next month. If your application is received after the 20th, coverage will take effect on the first day of the following month. For example, coverage for an application received May 19th will begin on June 1st. Coverage for an application received May 21st will begin July 1st.

2. Who is eligible for Dental Blue^®?

A: You and your dependents who are residents of North Carolina are eligible. Additionally, spouses and unmarried children under the age of 19 (age 26 if the child is a full-time student) also count as eligible dependents. A child who is a North Carolina resident may have an individual policy in their name. A person is ineligible if they have had a Dental Blue^® for Individuals policy within the last 12 months.

3. Do I have to choose a dentist in BCBSNC®'s network?

A: No. Dental Blue^® for Individuals gives you the freedom to see any licensed dentist you wish.

4. What are waiting periods and how do they apply to me?

A: Waiting periods are the time from your effective date to the day when you can receive a covered service. With Dental Blue^® for Individuals, the waiting period for basic services is six months and for major services, it is 12 months. Refer to your benefit booklet for a listing of basic and major services.

NOTE: There are no waiting periods for preventive and diagnostic services.

5. What does my deductible apply to?

A: Your $75 deductible applies to basic and major services. After this deductible is met, Dental Blue^® pays 60% of covered basic services and 50% of covered major services, up to your annual maximum of $1,000. Each member under your policy has a $75 deductible for basic and major services.

6. How do I file a claim?

A: Unless your dentist accepts assignment of benefits, you should pay the dentist in full and submit a claim to BCBSNC® so that you can be reimbursed. Simply fill-out and mail it to:

BCBSNC® Claims Unit
PO Box 30568
Salt Lake City, UT 84130-0568

Be certain to mail it so that it is received within 180 days of your services.

7. How else can Customer Service assist me?

A: Representatives can assist you if you have questions regarding claims payment, explanation of benefits (EOBs), pre-treatment estimates, and other general questions regarding your benefits. Hours of operation are 8:30 a.m. to 8:00 p.m. Monday through Thursday, and 9:00 a.m. to 8:00 p.m. on Friday.

8. How does my dentist know I'm eligible to receive benefits?

A: Each time you visit the dentist, you should present your BCBSNC® ID card. Additionally, the dentist can contact Customer Service to verify your benefits and eligibility. Eligibility can be verified 24 hours a day, seven days a week through our automated system.

9. Is orthodontic care covered?

A: No. Dental Blue^® for Individuals does not provide coverage for orthodontic care.

10. How do you determine the allowable charge?

A: BCBSNC®'s allowable charge is based on 85% of the HIAA (Health Insurance Association of America) index. This means 85% of dentists in that zip code area charge equal to or less than our allowable charge.

11. Can I cancel coverage and reapply again a short time later?

A: No. If you cancel your coverage, there is a 12 month waiting period before you can purchase another Dental Blue^® for Individuals policy.

12. When are my rates subject to change?

A: On your renewal, which is January 1st of each year.

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