Blue Cross and Blue Shield of North Carolina® Dental Insurance
1. When does my Dental Bluesm for Individuals coverage begin?
A: Your coverage can begin on the 1st or 15th of the month. Application must be submitted at least 7 days in advance.
2. Who is eligible for Dental Bluesm for Individuals?
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 Bluesm for Individuals policy within the last 12 months.
3. Do I have to choose a dentist in BCBSNC®'s network?
A: No. Dental Bluesm 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 Bluesm 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 Bluesm for Individuals 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.
For benefit questions call toll free 1-800-305-6638.
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 Bluesm 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 Bluesm for Individuals policy.
12. When are my rates subject to change?
A: On your renewal, which is January 1st of each year.