Blue Cross Blue Shield of North Carolina wants you to know that your kids matter and we have them covered from head to toe with pediatric dental and vision benefits. Pediatric dental and vision coverage, including orthodontia services, is considered one of the Affordable Care Act’s 10 essential health benefits required on all qualified health plans. This coverage is no longer part of a separate Dental Blue policy, but rather included in Blue Cross Blue Shield of North Carolina’s medical policies. What this means is that you no longer have to purchase a separate dental policy for children under the age of 19 and pediatric vision benefits are embedded into your child’s medical plan, giving you the confidence of knowing your kids are covered.
Below is a general summary of the coverage you can expect; however, you should always review the benefit details of your individual policy.
- One preventive eye exam per benefit period: (For individual plans copay or deductible/coninsurance apply depending on the plan)
- One pair of lenses and frames or one pair of contact lenses covered at 50% after the deductible: (Disposable contact lenses are not covered)
- The provider must file the claim for lenses and frames.
Diagnostic and Preventive Services: (oral evaluations, cleanings, X-rays, topical fluoride, sealants, and more)
- In-network: $25 copayment
- Out-of-network: $50 copayment
Basic/Major Services: (routine fillings, simple extractions, stainless steel crowns, surgical tooth removal, inlays, onlays, crowns, and more)
- In-network: 20% after medical deductible
- Out-of-network: 40% after medical deductible
Medically Necessary Orthodontia:
- Covered the same as Basic/Major Services
- 12 month waiting period (from the member’s effective date) applies
Whether your son needs eye glasses or your daughter needs sealants, BCBSNC is here to help with pediatric dental and vision coverage included in all health plans. See what makes a Blue Cross Blue Shield of North Carolina health plan the perfect coverage for you and your kids!
For more information on Blue Cross Blue Shield of North Carolina health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents. Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.