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 Blue Cross NC'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 Blue Cross NC so that you can be reimbursed. Simply fill-out and mail it to:
Blue Cross NC 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 Blue Cross NC 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: Blue Cross NC'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.