Our patients who are covered by a dental insurance plan have a big advantage when it comes to enjoying excellent oral health and a lasting smile. If your employer offers Blue Cross Blue Shield of Texas, that’s great news -- we are pleased to be the dentist in Texarkana who you can turn to for superior affordable care! Our team of experts is here to help you enjoy dentistry that is as high-class as it is easy to budget for. Keep reading to learn more about how we can help you make the most out of your Blue Cross coverage, for the good of your smile AND your wallet.
Blue Cross Blue Shield Coverage Availability & Fees
Blue Cross Blue Shield is one of the most popular providers of dental insurance in Texas and across the United States. The aim of this plan (as well as most dental insurance providers) is to help members achieve and maintain positive oral health through routine preventive care and early detection. With a twice-annual checkup and cleaning, we can help you avoid problems like cavities and gum disease altogether.
Dental insurance coverage can vary based on certain choices made at the time of enrollment, but in general, you can expect your Blue Cross Blue Shield coverage to work like this:
- Preventive dentistry is 100% covered: Six month checkups and cleanings, X-rays, dental sealants, and fluoride treatments
- Restorative dentistry is covered between 50% and 80%: Basic fillings, dental crowns, root canal therapy, extraction, etc.
By visiting an in-network provider like us, you are able receive your discounts and coverage immediately. No paying extra out-of-pocket and then waiting around for a reimbursement to come later, if at all -- we’ll take care of everything for you!
Meet Christine, Who Handles Dental Insurance
Our team of experts is on hand to help you with everything related to your dental experience, and that includes using your dental insurance! At Pleasant Grove Family Dentistry, our resident insurance expert is Christine. She is our business administrator and has been since 2002. Patients and our staff alike always notice her grace and smile, even when things feel like things are going 90 miles a minute around here.
Yes, Christine is an expert in the behind-the-scenes workings of our dental practice, and a big portion of that is dental insurance. When you visit our office with Blue Cross Blue Shield coverage, she will begin by performing a verification of benefits to find out just what you are eligible for. Once we have this information, we can begin helping you stretch your benefits -- like by breaking up larger dental treatments over two calendar years to reduce out-of-pocket costs, for example.
No matter what your dental needs are, Blue Cross Blue Shield can help make it easier to pay for quality dental work. We invite you to contact us to discuss your coverage with Christine today!
As a member of Blue Cross Blue Shield FEP Dental, we aim to provide the highest level of service available. Below are answers to some of the frequently asked questions.
If you can't find what you're looking for, please visit our Contact Us page for further assistance.
Why should I get dental coverage?
A complete dental examination involves many things including checking the status of the gums, teeth, any restorations (fillings, crowns, veneers, etc.), and oral mucosa of tongue, cheeks, top and bottom of mouth and back of throat. There are many problems that can develop in the mouth that don't hurt until they do, and then the treatment may be more extensive, expensive, or even too late to save a tooth or teeth. In addition, the importance of periodic evaluation of the oral mucosa is to look for lumps, bumps and other irregularities that may even be signs of disease...even cancer.
How is Blue Cross Blue Shield FEP Dental different than other dental plans? How is BCBS FEP Dental different than other dental plans?
Blue Cross Blue Shield FEP DentalBCBS FEP Dental offers several choices to our members. They are as follows:
- We have Standard Option and High Option.
- The annual maximum of benefits for in-network High Option is unlimited.
- The lifetime benefit maximum for High Option for Orthodontic Benefits is $3,500.
- If you are a Service Benefit Plan (SBP) member, dental claims are submitted on your behalf to the local Plan for processing.
How does Blue Cross Blue Shield FEP Dental work? How does BCBS FEP Dental work?
If you are a Service Benefit Plan member, and have enrolled in the Blue Cross Blue ShieldBCBS FEP Dental Program and have visited the dentist, the dental provider sends the claim to the local Plan (or other carrier listed on your medical I.D. card) for processing and issuing an Explanation of Benefits (EOB). At the same time, the claim along with any balance will be forwarded to Blue Cross Blue ShieldBCBS FEP Dental. Blue Cross Blue ShieldBCBS FEP Dental will process the claim for secondary payment. The member will also receive an EOB from Blue Cross Blue ShieldBCBS FEP Dental.
What's covered with Blue Cross Blue Shield FEP Dental? What's covered with BCBS FEP Dental?
Basic services, which include oral examinations, prophylaxis, diagnostic evaluations, sealants and X-rays.
Intermediate services, which include restorative procedures such as fillings, prefabricated stainless steel crowns, periodontal scaling, tooth extractions, and denture adjustments.
Major services, which include endodontic services such as root canals; periodontal services such as gingivectomy; major restorative services such as crowns, oral surgery, and bridges; and prosthodontic services such as complete dentures.
Orthodontic services are also included for both children and adults.
What's the difference between the Standard and High Options?
Check chart below:
Benefits ChartBenefits Chart - High Option
| IN-NETWORKOUT-OF-NETWORKIN-NETWORKOUT-OF-NETWORK | |||
| You pay nothing | You pay 10% | You pay nothing | You pay 40% |
| You pay 30% | You pay 40% | You pay 45% | You pay 60% |
| You pay 50% | You pay 60% | You pay 65% | You pay 80% |
| You pay 50% up to $3,500 lifetime maximum per person | You pay 50% up to $3,500 lifetime maximum per person | You pay 50% up to $2,500 lifetime maximum per person | You pay 50% up to $1,250 lifetime maximum per person |
| You pay no deductible | You pay $50 per person | You pay no deductible | You pay $75 per person |
| No benefit limit | We pay up to $3,000 per person | We pay up to $1,500 per person | We pay up to $750 per person |
Benefits Chart - Standard Option
| IN-NETWORKOUT-OF-NETWORK | |
| You pay nothing | You pay 40% |
| You pay 45% | You pay 60% |
| You pay 65% | You pay 80% |
| You pay 50% up to $2,500 lifetime maximum per person | You pay 50% up to $1,250 lifetime maximum per person |
| You pay no deductible. | You pay $75 per person |
| We pay up to $1,500 per person | We pay up to $750 per person |
Does Blue Cross Blue Shield FEP Dental offer a Self Plus One Option? Does BCBS FEP Dental offer a Self Plus One Option?
Yes, Blue Cross Blue ShieldBCBS FEP Dental offers a Self Plus One Option.
OPM establishes the options that will be available to Federal Employees. Eligible individuals can enroll in a dental and/or vision plan. They may enroll in a plan for Self Only, Self Plus One, or Self and Family coverage. Eligible family members include your spouse and unmarried dependent children under age 22. This includes legally adopted children and recognized natural children who meet certain dependency requirements. This also includes stepchildren and foster children who live with you in a regular parent-child relationship. Under certain circumstances, you may also continue coverage for a disabled child 22 years of age or older who is incapable of self-support.
For Retired Uniform Service members, eligible family members include your spouse, unmarried widow, unremarried widower, unmarried child, an unremarried former spouse who meets the U.S. Department of Defense's 20-20-20 or 20-20-15 eligibility requirements, and certain unmarried persons placed in your legal custody by a court. Children include legally adopted children, stepchildren, and pre-adoptive children. Children and dependent unmarried persons must be under age 21 if they are not a student, under age 23 if they are a full-time student, or incapable of self-support because of mental or physical incapacity.
FEDVIP rules and FEHB rules for family member eligibility are NOT the same. However, the Service Benefit Plan does offer a Self Plus One Option.
Is orthodontic treatment (braces) covered?
Yes, orthodontic services treatment and braces are covered for children and adults. The lifetime maximum amount is up to $3,500 for the High Option in-network and 50% of the allowed amount out-of-network. Under the Standard Option, the lifetime maximum is up to $2,500 for in-network services and up to $1,250 for out-of-network services.
How many dental visits per year are covered?
Exams are limited to 2 per year. Cleanings are limited to 3 per year. There are no restrictions on the visits per year. There are, however, limits to annual benefit dollars paid as well as lifetime limits on orthodontia.
Is there a missing tooth clause?
No. Benefits are available to replace missing or broken teeth under Prosthodontic Services.
Is my dependent eligible for coverage? Does the Affordable Care Act expand FEDVIP coverage for dependents up to age 26?
No, coverage for dependents ends at age 22 for Federal Employees. Eligible family members include your spouse and unmarried dependent children under age 22. This includes legally adopted children. Stepchildren and foster children who live with you in a regular parent-child relationship are also included. For Retired Uniform Service members, unmarried dependent children may be included on your coverage if under age 21 if they are not a student or under age 23 if they are a full-time student. FEHB provides coverage for dependents up to age 26.
What will I pay out-of-pocket? Will I have to pay up front? Is there a deductible?
There is a $75 deductible per person for Standard Option and $50 deductible per person for High Option when you use an out-of-network provider. A deductible is a fixed amount of expenses you must incur for certain covered services and supplies before we will pay for covered services. You are also required to pay a coinsurance amount after meeting your deductible for out-of-network services and class B and C services. A coinsurance is the percentage of our allowance that you must pay for your care.
In most cases, you will not have to pay anything up front; the provider will bill you for any owed amount.
What if I need emergency care while traveling outside the United States?
Blue Cross Blue ShieldBCBS FEP Dental plans include international coverage. Members may receive dental treatment from a dentist when they work or travel abroad. This service is available in approximately 100 countries throughout Europe, Africa, North America, South America and Asia. English-speaking customer service representatives are available to help members find a dentist. The list of participating dentists is available on this web site under Find a Provider. You are responsible for paying the dentist and submitting your claims to Blue Cross Blue ShieldBCBS FEP Dental. For more information, refer to our International Services web page or call Customer Service at 1-855-504 BLUE (2583) in the U.S. or 1-651-994-2583 collect outside the U.S.
Are FEDVIP rules and FEHB rules different as to eligible age requirements?
Yes, FEDVIP age requirements for eligibility are unmarried dependent children under age 22 for Federal Employees. This includes legally adopted, natural children, stepchildren, and foster children in a regular parent-child relationship. For Retired Uniform Service members, unmarried dependent children may be included on your coverage if under age 21 if they are not a student or under age 23 if they are a full-time student. The FEHB rules view unmarried or married children under the age of 26 as eligible.
How does this coverage differ from the medical coverage included in the Service Benefit Plan Basic or Standard Option?
BCBSBlue Cross Blue Shield FEP Dental provides comprehensive dental coverage your medical coverage does not provide. For instance, Blue Cross Blue ShieldBCBS FEP Dental will cover a percentage of your charges for services such as crowns, root canals, periodontal scaling, dentures, and orthodontic. Whereas the medical coverage is limited to services such as exams, cleanings, some X-rays, etc.
What is the difference between Blue Cross Blue Shield FEP Dental and Federal DentalBlue? What is the difference between BCBS FEP Dental and Federal DentalBlue?
With Blue Cross Blue ShieldBCBS FEP Dental, you automatically pay premiums through payroll deductions using pre-tax dollars. Annuitants/retired uniformed service members automatically pay premiums through annuity deductions using post-tax dollars. The FEDVIP rules are not applicable to Federal DentalBlue.
Blue Cross Blue ShieldBCBS FEP Dental is a nationwide program and also covers overseas employees. Federal DentalBlue is only offered in a few states.
Can I keep Federal DentalBlue coverage?
Yes, you can keep your Federal DentalBlue coverage, but it will not be subject to payroll deductions and unlike Blue Cross Blue ShieldBCBS FEP Dental, it will not have the tax advantages.
How will Blue Cross Blue Shield FEP Dental coordinate with my medical benefits? How will BCBS FEP Dental coordinate with my medical benefits?
Simple! If you have our medical coverage your benefits will automatically be coordinated with Blue Cross Blue ShieldBCBS FEP Dental. Just show your dental I.D. card and your medical I.D. card to your dentist. Your dentist will file directly with the local BCBS Plan (or other medical carrier listed on your medical coverage I.D. card) for primary coverage and then the claim will be sent to Blue Cross Blue ShieldBCBS FEP Dental making it seamless to you and your dentist.
How does Blue Cross Blue Shield FEP Dental work with my Flexible Spending Account (FSA)? How does BCBS FEP Dental work with my Flexible Spending Account (FSA)?
You can submit your FEDVIP co-payments/deductibles as eligible expenses against your FSA account. However, FEDVIP insurance premiums are not reimbursable under an FSA.
The Paperless Reimbursement (PR) is an optional program available to Blue Cross Blue ShieldBCBS FEP Dental participants who have elected to participate in the FSAFEDS program. Participants can have their out-of-pocket dental expenses sent electronically from Blue Cross Blue ShieldBCBS FEP Dental to FSAFEDS for processing towards their health care FSA account. To enroll in PR, visit www.FSAFEDS.com and log into "My Account Summary", then Paperless Reimbursement. You may also contact FSAFEDS at 1-877-FSAFEDS (372-3337), TTY: 1-800-952-0450, Monday through Friday, 9 AM- 9 PM EST.
Do you offer a package deal for Blue Cross Blue Shield FEP Vision and Blue Cross Blue Shield FEP Dental? Do you offer a package deal for BCBS FEP Vision and BCBS FEP Dental?
What kinds of dental providers can my family and I visit?
You can obtain care from any licensed dentist in the United States or overseas. You are not required to select a primary care dentist. Members are free to select the dentist of their choice. If you use an in-network provider, you are responsible only for covered charges up to our negotiated plan allowance per procedure.
If the dentist you use is not part of our network, benefits will be considered out-of-network. Because these providers are out of our network, we pay for their services based on an out-of-network plan allowance. You are responsible for the difference between the plan's payment and the amount billed.
How many providers does Blue Cross Blue Shield FEP Dental offer nationwide? How many providers does Blue Cross Blue Shield FEP Dental offer in my state/region? How many providers does BCBS FEP Dental offer nationwide? How many providers does BCBS FEP Dental offer in my state/region?
There are nearly half a million access points nationwide to receive in-network services. To find a provider in your area, please visit www.bcbsfepdental.com and select Find A Provider or call 1-855-504-BLUE (2583).
How do I find in-network dentists?
You can find the in-network dentists on our website - www.bcbsfepdental.com and select Find A Provider or call 1-855-504-BLUE (2583).
Should I verify that my dentist is an in-network dentist?
Yes. By checking with your dentist or looking on www.bcbsfepdental.com (select Find a Provider), you are assured that your dentist is still participating in the network. Additionally, only providers listed with their corresponding locations are in network. Not all dentists at a location may be in network and the same provider at a different location may not be in network. It is your responsibility to ensure the listed provider is active and in network at the time you receive services. Consult your Blue Cross Blue Shield FEP Dental Brochure for more information regarding your plan design.
Will I pay more if I use an out-of-network dentist? How much more?
Yes, generally you will pay less out of your pocket if you use our in-network dentists. If the dentist you use is not part of our network, benefits will be determined based on the out-of-network benefit level. Because these providers are out of our network, payment will be based on the lesser of the provider's actual charge or the maximum allowed amounts established by Blue Cross Blue Shield FEP Dental for services rendered by out-of-network providers. You are responsible for the difference between our payment and the amount billed. If a member chooses to go out of network, payment will be made directly to the member. Additionally, if you use an out-of-network dentist you may have to pay the dentist first, and then submit the claim to Blue Cross Blue Shield FEP Dental.
Benefits ChartBenefits Chart - High Option
| IN-NETWORKOUT-OF-NETWORKIN-NETWORKOUT-OF-NETWORK | |||
| You pay nothing | You pay 10% | You pay nothing | You pay 40% |
| You pay 30% | You pay 40% | You pay 45% | You pay 60% |
| You pay 50% | You pay 60% | You pay 65% | You pay 80% |
| You pay 50% up to $3,500 lifetime maximum per person | You pay 50% up to $3,500 lifetime maximum per person | You pay 50% up to $2,500 lifetime maximum per person | You pay 50% up to $1,250 lifetime maximum per person |
| You pay no deductible | You pay $50 per person | You pay no deductible | You pay $75 per person |
| No benefit limit | We pay up to $3,000 per person | We pay up to $1,500 per person | We pay up to $750 per person |
Benefits Chart - Standard Option
| IN-NETWORKOUT-OF-NETWORK | |
| You pay nothing | You pay 40% |
| You pay 45% | You pay 60% |
| You pay 65% | You pay 80% |
| You pay 50% up to $2,500 lifetime maximum per person | You pay 50% up to $1,250 lifetime maximum per person |
| You pay no deductible. | You pay $75 per person |
| We pay up to $1,500 per person | We pay up to $750 per person |
What will I pay out-of-pocket? Will I have to pay up front? Is there a deductible?
There is a $75 deductible per person for Standard Option and $50 deductible per person for High Option when you use an out-of-network provider. A deductible is a fixed amount of expenses you must incur for certain covered services and supplies before we will pay for covered services. You are also required to pay a coinsurance amount after meeting your deductible for out-of-network services and class B and C services. A coinsurance is the percentage of our allowance that you must pay for your care.
In most cases, you will not have to pay anything up front; the provider will bill you for any owed amount.
How do I know which dentist to select?
Get recommendations from friends, neighbors, coworkers and family members to find a dentist who matches your needs and values. A convenient location and clinic hours, possibly including Saturday and evening hours, may also be important considerations for you.
Having a dentist whom you visit regularly and feel comfortable with is important to your overall oral health. The dentist you select should be someone you can talk to, who will listen to your questions and concerns and who will answer your questions fully. Here are some questions to ask when selecting a dentist:
- How are after-hour emergencies handled?
- Does the dentist have multi-office locations?
- How long will you have to wait to get an appointment for routine exams and cleanings? Urgent or same-day care? Specialty services?
- Is the office staff friendly and helpful? Do they enjoy working with children?
How can I make the most of my dental visit?
- Show your Blue Cross Blue ShieldBCBS FEP Dental I.D. card and medical I.D. card (if applicable) at the time of each dental visit.
- To assure that you receive full plan benefits, verify that your dentist participates in the Blue Cross Blue ShieldBCBS FEP Dental network as indicated on your I.D. card.
- Discuss treatment options and costs with your dentist to help you select the best course of treatment.
- Ask in advance if all recommended services are necessary and if there are alternatives available.
- Check your Explanation of Benefits statement to make sure you received the services on this statement.
- Finally, make sure you understand your particular benefit plan and are familiar with the specific benefits that it covers.
How do I make decisions about dental procedures?
Start by asking questions. Having more information puts you in a better position to make informed decisions. Depending on your situation, you might consider asking the following questions:
- How much discomfort should I expect?
- Can I expect all my symptoms to go away? When?
- Will I need to make any changes in my lifestyle?
- What is the cost of the treatment? What will the cost be to me?
- What alternatives are available?
- How many times have you done this procedure? How do your results compare with other dentists?
- Will you send a treatment plan to Blue Cross Blue ShieldBCBS FEP Dental for an estimate of benefits? How long will it take to get the pre-estimate back?
- What kind of follow-up care do I need?
- How will I look when the procedure has been completed?
- What could happen if I delay this treatment?
- How can I best care for my mouth after the treatment?
Who do I call for customer service?
You can reach our dedicated Customer Service department at 1-855-504-BLUE (2583) 8 a.m. - 8 p.m. Eastern Time, Monday - Friday.
Who do I contact with a change of address?
Report your new address to BENEFEDS by visiting www.BENEFEDS.com or calling 1-877-888-FEDS (3337), TTY 1-877-889-5680. BENEFEDS will forward your address change to us. And, when visiting your dentist, make sure they have your correct address to use when submitting claims.