Dental
While you can visit any licensed dentist, your cost is lower when you visit a dentist in the Blue Shield PPO network. Our carrier pays based on their fee schedule to out-of-network dental providers, so you could see a balance bill for any service provided by an out-of-network provider including preventive care. Blue Shield will only pay up to their contract allowances which may not be your dentist’s actual fees. You will be responsible for the difference or balance billing should you use providers outside the networks.
Bronze DPPO 1500-MAC |
||
|---|---|---|
| Plan Features | In-network | Out-network |
| Annual Maximum | $1,500 | $1,500 |
| Deductible | $50 Per Individual $150 Per Family | $50 per person $150 per family |
| Diagnostic & Preventive Services Exams, Cleanings, X-Rays and Sealants | 100% deductible waived | 80% deductible waived |
| Basic Services Fillings and Composites Endodontics (Root Canals) Oral Surgery Non-Surgical Periodontics (Gum Treatment) | 80% | 70% |
| Major Services Crowns, Inlays, Onlays, and Cast Restorations Surgical Periodontics | 50% | 50% |
| Prosthodontics Bridges and Dentures | 50% | 50% |
| Orthodontia | Not Covered | |
The Dental DHMO Plan encourages preventive treatment and allows you to achieve good oral health while minimizing your out-of-pocket dental expenses. The Plan is administered by Blue Shield. The Dental DHMO Plan encourages preventive treatment and allows you to achieve good oral health while minimizing your out-of-pocket dental expenses. The Plan is administered by Blue Shield. Meissner Mfg. Co., Inc. pays 100% of your enrolled premium for DHMO employee only dental coverage if you elect this coverage. These are your cost per pay period (bi-weekly), paid with pre-tax payroll deductions:
Dental HMO Deluxe |
|
|---|---|
| Plan Features | DHMO Dental Plan |
| Annual Maximum | Unlimited |
| Deductible | No Deductible |
| Diagnostic & Preventive Services Exams, Cleanings, X-Rays and Sealants | No Charge |
| Basic Services Fillings and Composites Endodontics (Root Canals) Oral Surgery Non-Surgical Periodontics (Gum Treatment) | $0 - $15 copay |
| Major Services Crowns, Inlays, Onlays, and Cast Restorations Surgical Periodontics | $50 - $200 copay |
| Orthodontia | Child(ren) $1,500 Adult $1,200 |
Employee BI-WEEKLY cost (26 payroll cycles)
| Enrollment Tier | Employee BI-WEEKLY cost (26 payroll cycles) |
|---|---|
| BLUE SHIELD DENTAL HMO | |
| Employee Only | $0.00 |
| Employee & Spouse | $10.15 |
| Employee & Child(ren) | $13.48 |
| Employee & Family | $20.22 |
| BLUE SHIELD DENTAL DPPO | |
| Employee Only | $5.91 |
| Employee & Spouse | $21.83 |
| Employee & Child(ren) | $29.82 |
| Employee & Family | $44.12 |