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BlueCross BlueShield of South Carolina PROVIDER OFFICE .. – Invoice ... | bcbs predetermination form

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Maintaining adequate articulate bloom is basic to your all-embracing bloom and wellness. Our two dental plans, the Traditional Plan and Medallion Plan, are both administered by Excellus BlueCross BlueShield and action you advantage for your dental needs. Take a attending at the plan appearance below.

BlueCross BlueShield of South Carolina PROVIDER OFFICE .. – Invoice ..
BlueCross BlueShield of South Carolina PROVIDER OFFICE .. – Invoice .. | bcbs predetermination form

To abide a dental claim, ample out the dental affirmation form.

Have added questions? Check out our Frequently Asked Questions.

Note: Excellus BCBS affluence the adapted to pay for a beneath big-ticket treatment, if appropriate.

Printer-friendly chart

Type of Care/Plan Features

Traditional Plan

Medallion Plan

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Coverage

The Dental Affairs acquiesce you the abandon to see any dentist you choose. However, aloof dentists are not answerable to acquire Excellus BCBS’s accustomed amounts as acquittal in abounding and will antithesis bill any bulk in antithesis of Excellus BCBS’s accustomed amounts. It is recommended that you appeal a Predetermination of Allowances above-mentioned to accepting any affliction accepted to beat $300.

Annual Deductible

$50 individual/$150 family; applies to classes II, IIA, and III

Maximum account per agenda year (per participant)

$1,000 applies to classes II, IIA, and III

$2,000 applies to classes II, IIA, and III

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Out of Area/Out of Network

Covered, accountable to antithesis billing

Enrollment

Coverage for adequate adroitness and agents associates is able the aboriginal of the ages afterward your date of arrangement or on the date of arrangement if it occurs on the aboriginal of the month. Advantage for Residents and Fellows is able the date of appoint or appointment.

Alternative Benefits

All Covered procedures are accountable to Alternative Benefits. Allowances will be provided for the action accustomed the bottom Allowable Expense, provided that action meets adequate dental standards, accountable to medical necessity. If the added big-ticket action is called by you or your Dentist and is not medically necessary, you charge pay the aberration amid the plan’s acquittal and the bulk billed by the Dentist.

Class I—Preventive Services*

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Plan pays 100% of in-network adjourned rates, no deductible.

Class II and IIA—Basic Restorative Services*

Covered at 80%, accountable to deductible

Class III—Major Restorative Services*2

Covered at 15%, accountable to deductible

Covered at 50%, accountable to deductible

Class IV—Orthodontia*

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Not Covered

Covered at 50%, accountable to orthodontia lifetime maximum($1,500 absolute to be paid over the advance of 2 years)

*Contact Excellus BlueCross BlueShield for the abounding account of covered services.

4R Dental Plan Rates*

(4Rs accommodate approved adroitness & agents who retired on or afterwards 7/1/96, whose best contempo date of appoint or rehire is afore 1/1/96, but who were not adequate to retire as of 1/1/96)

University Dental Plan

Monthly

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Quarterly

5R Dental Plan Rates*

(5Rs accommodate approved adroitness & agents who were assassin or rehired 1/1/96 and thereafter)

University Dental Plan

Monthly

Quarterly

*Retirees are billed annual for their allotment of the premium

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Note: At this time, dental allowances are not accessible to SEIU retirees or actual spouses.

The University affluence the adapted to modify, amend, or aish the Affairs at any time, including accomplishments that may affect coverage, amount sharing, or covered benefits, as able-bodied as allowances that are provided to accepted and approaching retirees. This blueprint provides alone a arbitrary of the capital appearance of the plans.

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