Plan 65 - Dental
This optional program is only available to you at the time you enroll in your health program. Coverage may not be added at a later date.
These benefits are covered at 100 percent of the allowable charge:
- Oral examinations - two per year
- Prophylaxis, including cleaning, scaling and polishing - two per year
- Dental x-rays required to treat or diagnose diseases or abnormalities of the teeth, surrounding tissue and cavity detection (limited to two bitewing x-rays per year and one full mouth x-ray during a five-year period)
These benefits are covered at 80 percent of the allowable charge, following a $50 annual deductible, to an annual maximum benefit payment of $1,000 each calendar year:
- Simple extractions
- Fillings (except gold)
- Root canal treatment
- Periodontic treatment of the gums, consisting of examination, management and surgery
- Extraction of impacted teeth
- Repair of dentures
- General anesthesia when the dental treatment is a covered service
Please note: With this optional dental program, you will need to use a Blue Cross and Blue Shield of Kansas contracting dentist to receive maximum benefits.
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