BCBSAZ Dental & Vision Plans

BlueCross BlueShield Arizona Dental Plan

Dental Brochure

Getting the dental and vision plans you need

Off-exchange, standalone coverage from BlueCross BlueShield of Arizona can help you get the dental and vision care you need for your total health. Many of our dental plans cover you 100% for exams, cleanings and X-rays.

All-in-one or separate plans?

You can buy a medical plan that includes dental and vision benefits — or you can buy separate plans. You may want to think about buying your dental and vision separate from your medical plan. Separate plans usually offer more choices and may have more benefits to meet your needs. The main differences are in how you apply for coverage and how you are billed.

Blue Preferred Dental Benefits

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BluePreferred Individual Dental PPO plans offer 100% in-network coverage for covered diagnostic and preventive services. This means that common covered services such as two yearly exams and cleanings, and some x-rays are provided with no out-of-pocket expenses when network dentists are used. And the network is extensive with licensed dentists located throughout Arizona. Three different plan designs are available.
This is only a brief summary of benefits to guide your shopping experience and to help you compare plan differences. Please review the plan Benefit Summary for your chosen plan before you apply for coverage.

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	Monthly Rates	Annual Deductible	In-Network Coinsurance (Plan Pays / Member Pays)	Out of Network Coinsurance (Plan Pays / Member Pays)	Annual Plan Maximum
BluePreferred Dental Plan 1i View Details	Under 19: $14.87 19 and older: $18.13	$50	Type I: 100% / 0% Type II: 80% / 20% Type III: Not Covered	Type I: 80% / 20% Type II: 60% / 40% Type III: Not Covered	$500
BluePreferred Dental Plan 5i View Details	Under 19: $26.50 19 and older: $32.32	$50	Type I: 100% / 0% Type II: 80% / 20% Type III: 50% / 50%	Type I: 80% / 20% Type II: 60% / 40% Type III: 40% / 60%	$1,000
BluePreferred Dental Plan 6i View Details	Under 19: $28.79 19 and older: $35.11	$50	Type I: 100% / 0% Type II: 80% / 20% Type III: 50% / 50%	Type I: 80% / 20% Type II: 60% / 40% Type III: 40% / 60%	$1,500

Monthly Rates

Annual Deductible

In-Network Coinsurance (Plan Pays / Member Pays)

Out of Network Coinsurance (Plan Pays / Member Pays)

Annual Plan Maximum

BluePreferred Dental Plan 1i

View Details

Under 19: $14.87
19 and older: $18.13

$50

Type I: 100% / 0%
Type II: 80% / 20%
Type III: Not Covered

Type I: 80% / 20%
Type II: 60% / 40%
Type III: Not Covered

$500

BluePreferred Dental Plan 5i

View Details

Under 19: $26.50
19 and older: $32.32

$50

Type I: 100% / 0%
Type II: 80% / 20%
Type III: 50% / 50%

Type I: 80% / 20%
Type II: 60% / 40%
Type III: 40% / 60%

$1,000

BluePreferred Dental Plan 6i

View Details

Under 19: $28.79
19 and older: $35.11

$50

Type I: 100% / 0%
Type II: 80% / 20%
Type III: 50% / 50%

Type I: 80% / 20%
Type II: 60% / 40%
Type III: 40% / 60%

$1,500

Disclaimer

Important Notice: All plans have a 6 month waiting period for type II services and 12-month waiting period for type III services. The annual plan maximum is the most that the plan will pay for covered services during a plan year. After you reach the maximum, no further services are covered. For detailed information about benefits, waiting periods, limitations and exclusions, refer to the specific provisions found within the benefit plan booklet. If the benefits on this comparison differ from those stated in the benefit plan booklet, the terms of the benefit plan booklet apply. There is no guarantee of continued benefits outlined in this comparison or the benefit plan booklet.

BlueCross BlueShield of Arizona

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