Dental Summary

Summary of Benefits Anthem Dental Essential Choice Total Education Solutions Anthem Blue Cross Dental Complete Network WELCOME TO YOUR DENTAL PLAN! Regular dental checkups can help find early warning signs of certain health problems, which means you can get the care you need to get healthy. So, don't skimp on your dental care, good oral care can mean better overall health! Powerful and easily accessible member tools. Dentists in your plan network. ● Ask a Hygienist: Dental members can simply email their dental ● You'll save money when you visit a dentist in your plan questions to a team of licensed dental professionals who in turn will network because Anthem Blue Cross (Anthem) respond in about 24 hours. and the dentist have agreed on pricing for covered services. ● Dental Health Risk Assessment: We want our dental members Dentists who are not in your plan network have not agreed to better understand their oral health and their risk factors for tooth to pricing, and may bill you for the difference between what decay, gum disease and oral cancer. This easy to use online tool can Anthem pays them and what the dentist usually help them do this. charges. ● Dental Care Cost Estimator: In order to help our dental member ● To find a dentist by name or location, go to better understand the cost of their dental care, we offer access to a anthem.com/ca or call dental customer service at the user-friendly, web-based tool that provides estimates on common number listed on the back of your ID card. dental procedures and treatments when using a network dentist. ● More Capabilities: With our latest mobile application, members can find Ready to use your dental benefits? a network dentist as well as view their claims. Our application is available ● Choose a dentist from the network for both Android and Apple phones. ● Make an appointment ● Show the office staff your member ID card ● Pay any deductible or copay that is part of your plan Need to contact us? See the back of your ID card for who to call, write or email us. Your dental benefits at a glance The following benefit summary outlines how your dental plan works and provides you with a quick reference of your dental plan benefits. For complete coverage details, please refer to your policy. In-Network Out-of-Network Coverage Year Calendar Year Annual Benefit Maximum ● Per insured person $2,000 $2,000 ● Diagnostic & Preventive Services are applied to the Annual Maximum Annual Maximum Carryover No No Orthodontic Lifetime Benefit Maximum ● Per eligible person $1,000 $1,000 Annual Deductible ● Per insured person $50 $50 ● Family maximum 3x single member 3x single member deductible deductible Deductible Waived for Diagnostic/Preventive Services Yes Yes Out-of-Network Reimbursement: 90th percentile Anthem Blue Cross Life and Health Insurance Company is an independent licensee of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. QuoteID: 00942573 Page 1 of 3