LARGE GROUP AGENT GUIDE - BLUEDENTAL PLANS BLUEDENTAL CARESM BLUEDENTAL CHOICESM BLUEDENTAL CHOICE PLUSSM BLUEDENTAL CHOICESM COPAYMENT - FLORIDA ...
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BlueDental Plans
BlueDental Care
SM
BlueDental Choice SM
BlueDental Choice Plus SM
BlueDental Choice Copayment
SM
Large Group Agent Guide
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The Medical & Dental Connection
An undeniable relationship exists between a healthy mouth and overall good health. That means it’s more
important than ever for individuals to get regular preventive dental care that will help to maintain or improve good
oral and overall health. Infections, nutritional deficiencies and even diseases such as diabetes, heart disease and
stroke often appear in the mouth as well as the body. High levels of bacteria in the mouth lead to higher levels of
bacteria in the body, which can be a factor in certain diseases.
An undeniable relationship exists between a healthy mouth and good overall health. That means it’s more
important than ever for individuals to get regular preventive dental care that will help to maintain or improve good
oral and overall health.
Our ability to integrate medical and dental claims information may have a positive impact on members overall
health and claims experience. Our Oral Health for Overall Health approach makes financial sense not only for
members, but also for employers as they look to increase productivity, lower absenteeism costs, and promote
employee overall health and satisfaction.
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The Medical & Dental Connection
The Oral Health for Overall Health program provides • Encouraging members who are not maintaining oral
enhanced dental benefits and focused attention on health to make an appointment with their dentist
additional dental education, including: • Removing financial barriers with enhanced dental
benefits:
• Informing our members about the connection – No copayments, coinsurance, and no
between oral and overall health deductible when visiting an in-network provider
• Educating our members about certain medical – Covered outside the annual maximum
conditions that may affect their oral and overall
health
Oral Cancer
Two Additional Screenings Once Periodontal
Cleanings or Every 6 Months Scaling* Covered
Automatic Periodontal & Fluoride 100% with No
Covered Medical Conditions Program Maintenance Treatments Once Out-of-Pocket
and Enhanced Dental Benefits Enrollment Visits per Year Every 3 Months Expense
Diabetes 3 3 3
Coronary Artery Disease 3 3 3
Stroke 3 3 3
Pregnancy 3 3
Oral Cancer 3 3 3
Head & Neck Cancers (As of January 1, 2020) 3 3 3
Sjögren’s Syndrome 3 3 3
*A member’s plan must include periodontal coverage to receive this benefit.
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PPO Dental Product Overview
With two of the strongest PPO dental networks in Florida, members can choose a dentist who participates in the
network for greater savings or choose any licensed dentist. Members also have access to a national network of
general dentists and specialists when traveling outside of Florida. Choose between BlueDental Choice, BlueDental
Choice Plus, or BlueDental Choice Copayment. All plans offer a variety of deductible and cost-sharing options to
create the ideal benefit package for your client.
Plan Selling Features
BlueDental Choice – A PPO that allows
members to choose from thousands of
in-network providers or an out-of-network • Two of the strongest PPO networks in Florida
provider with no authorizations or referrals • National network of 100,000+ general dentists and specialists
needed
• In and out-of-network benefits – members can choose any dentist
BlueDental Choice Plus – A premium PPO • Optional maximum rollover benefits
for groups of 51 employees or more that
comes with a provider network of thousands • Optional orthodontic benefits
of dentists, yet still pays usual-and-customary • Implants and composite resin fillings are covered benefits
fees for out-of-network care
• Value-added benefits
BlueDental Choice Copayment – A lower- • Enhanced dental benefits – condition specific benefits for members who
cost option with PPO flexibility, predictable have oral cancer, diabetes, coronary artery disease, Sjögren’s syndrome,
copayments, and an emphasis on preventive stroke or who are pregnant
care
Employer Contribution % Number of Lives Required
Minimum 50% - 100% employer contribution Greater of 10 lives enrolled or 50% of all eligible employees
4 0 - 49% employer contribution Greater of 10 lives enrolled or 35% of all eligible employees
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Prepaid Dental Product Overview
Prepaid Dental (PDP) BlueDental Care Services
• Coverage for implants (available on select plans)
• Oral cancer screening
• Adult fluoride
• Teeth whitening
Plan Selling Features
• No deductibles BlueDental Care – A prepaid plan that works like a DHMO – no
• No waiting period for coverage deductible, no annual maximum benefit, no claim forms, and little
or no cost for office visits and cleanings. Out-of-pocket costs for
• No annual maximum
in-network care are always known up front.
• No claim forms
The BlueDental Care plan is simple to quote and offers a variety of
• No restricted SIC codes plan design options. Some plans are available with orthodontics
• No employer contribution requirements and implants.
Compare Plans
FD310 FD305 FS305 FS295
Orthodontia coverage Optional Included
Dental implants N/A Optional Included
25% discount for covered services when visiting
Specialist coverage Includes specialists
a participating specialist
Lab fees are
Capped lab fees Not to exceed $200 Not to exceed $200
not capped
2 cleaning limit in any Additional 2
Adult/child cleanings 2 cleaning limit in any 12 calendar months
12 calendar months cleanings per year
4 eligible employees
with 4 enrolled
100 eligible
without implants;
Minimum eligibility 4 eligible employees with 4 enrolled employees with
10 eligible employees
10 enrolled
with 10 enrolled with
implants
Alachua, Brevard, Broward, Charlotte, Collier,
Alachua, Brevard, Broward, Collier, Duval,
Duval, Hernando, Hillsborough, Lake, Lee,
Limited service areas Hillsborough, Lee, Martin, Miami-Dade,
Manatee, Marion, Martin, Miami-Dade, Orange,
(no restricted SIC codes) Orange, Palm Beach, Pinellas, Polk, Sarasota,
Palm Beach, Pasco, Pinellas, Polk, Sarasota,
Seminole, St. Lucie, and Volusia
Seminole, St. Johns, St. Lucie, and Volusia
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BlueDental Group Product Matrix
BlueDental Choice & BlueDental Choice Plus BlueDental Choice Copayment BlueDental Care
Plan Benefit PPO Plans PPO Plans Prepaid Plans
In-Network1 Out-of-Network In-Network1 Out-of-Network In-Network Only
Provider Selection Any participating Any licensed Any participating Any licensed Any participating
Plan-Year
$500 to $5,000 $750, $1,000, or $1,500 Unlimited
Maximum
Individual
Deductible $25 to $150 $0 or $50 $50 No deductible
(Basic and Major)
Family Deductible 2X-3X or no limit 3X No deductible
Cleaning Copay N/A $0 or $10 $0
Choice - allowable charge
Benefit Choice Plus - Usual and
Fee schedule Fee schedule Allowable charge N/A
Reimbursement customary or 60 , 70 , 80 ,
th th th
90 percentile
th 2
Diagnostic and 100%, 80%, or 70%
40% to 100% Copayment No or low copay on
Preventive coinsurance paid by
coinsurance paid by BlueDental schedule most services
Services BlueDental
80%, 60%, or 50% Fixed copayment
40% to 100% Copayment
Basic Services coinsurance paid by amounts for
coinsurance paid by BlueDental schedule
BlueDental covered services
50%, 40%, or 35% Fixed copayment
0% to 100% Copayment
Major Services coinsurance paid by amounts for
coinsurance paid by BlueDental schedule
BlueDental covered services
Bitewing X-rays can move from
Preventive to Basic services
Flexibility of
Sealants, Full Mouth Panoramic X-rays can move Flexibility of services are not
Services N/A
from Basic to Preventive Services available with Copayment plans
Endodontics & Non-Surgical Periodontics can
move from Basic to Major Services
Orthodontia Fixed copayment on
Minimum 5 child/family Minimum 5 child/family
plans that offer
Rider units enrolled (optional) units enrolled (optional)
orthodontia coverage
Rollover Rider Optional Optional N/A
Waiting Period
on Major and
May apply on TG virgin or voluntary groups May apply on TG virgin or voluntary groups No waiting period
Orthodontia
Services3
Enhanced
Included4 Included4 N/A
Dental Benefits
25% reduction from
UCR for specialists’
services listed as
Value-Added covered in the member
Orthodontic and cosmetic discount5 Orthodontic and cosmetic discount5 certificate when
Benefits
provided by a
participating general
dentist or specialist
4 enrolled
Greater of 10 employees or Greater of 10 employees or employees for FD310,
Minimum 50% of eligibles for true group 50% of eligibles for true group FD305, and FS305
Participation plans; 10 enrolled
Requirement Greater of 10 employees or Greater of 10 employees or employees for FS295
35% of eligibles for voluntary 35% of eligibles for voluntary (groups 100+) or FS305
with implant coverage
True Group Minimum 50% – 100% True Group Minimum 50% – 100%
Employer employer contribution employer contribution See participating
Contribution requirements
Voluntary 0 – 49% employer contribution Voluntary 0 – 49% employer contribution
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National network available.
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The default percentile for BlueDental Choice Plus out-of-network benefits is Usual and Customary. Groups can buy up to the 60th, 70th, 80th, or 90th percentile.
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Waiting period may be waived for an additional premium for groups 51+.
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Members who have oral cancer, diabetes, coronary artery disease, Sjögren’s syndrome, stroke or are pregnant may be qualified for enhanced dental benefits. These condition-
specific benefits are paid at
100% and are not subject to deductibles, coinsurance, or calendar-year maximums when performed by a participating dental provider.
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Discounts for value-added orthodontic and cosmetic benefits are only available to insured members in Florida. Certain dentists have voluntarily agreed to offer a 20% discount
off their usual charge for non-covered cosmetic or orthodontic services. These dentists are identified by an affiliation to either the Cosmetic Dental Discount Program or
Orthodontic Discount Program. Because these dentists are neither contractually nor legally bound to offer these discounts, we recommend that you contact the provider to
6 inquire about the continued availability of any discount prior to scheduling an appointment.
NOTE: This chart highlights available BlueDental plans. A variety of specific plan combinations are available. BlueDental Choice Plus plans must be sold to groups with a
6 minimum of 51 employees. Benefit plan designs may be limited to specific combinations. BlueDental Care prepaid plans are available in limited service areas in Florida.
Value-Added Benefits/Optional Benefits
Optional Benefits Value-Added Benefits
Maximum Rollover Depending on the dental plan selected, members may
Depending on the dental plan selected, members may be eligible for value-added orthodontic and cosmetic
be eligible for Maximum Rollover. Maximum Rollover dentistry discounts.
is a BlueDental Choice benefit that rewards members
just for visiting the dentist. There is no paperwork to Orthodontic Discount* Program
complete. Each year when members visit the dentist Members that choose an orthodontist in our
and use less than the yearly claim payment threshold, orthodontist provider network will receive 20 percent
they receive rollover dollars to help cover future off their total case fee. This discount is available to
unexpected visits or higher out-of-pocket costs for members who do not have orthodontic coverage as part
complex procedures. It’s that easy. Maximum Rollover is of their plan.
applied automatically as long as:
Cosmetic Dentistry Discount* Program
• Members receive at least one covered service Members can experience significant savings on
during their plan year cosmetic dentistry procedures by visiting a dentist
• They are active members of their plan on the last who participates in our cosmetic dentistry network.
day of the plan year Members receive a 20 percent savings on the following
• They don’t exceed the claim payment threshold in procedures:
their plan year
• Cosmetic Contouring
Orthodontia Rider • Laminate Veneer (porcelain or composite)
A separate Orthodontia Rider is available for children up • Whitening (in office or at-home system)
to age 19 or for all insureds on many plans.
*Certain dentists have voluntarily agreed to offer a 20% discount off their usual charge for non-covered cosmetic or orthodontic services. These dentists are identified by an
affiliation to either the Cosmetic Dental Discount Program or Orthodontic Discount Program. Because these dentists are neither contractually nor legally bound to offer these
discounts, we recommend that you contact the provider to inquire about the continued availability of any discount prior to scheduling an appointment. 7
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Provider Directory
Navigating the Provider Directory National Network
Here’s how to help your clients find the dentist that From preventive services to specialist procedures,
best meets their needs: BlueDental Choice plans have your clients covered with
a choice of two dental networks – an extensive local
1. Go to FloridaBlueDental.com and click Find a
network and a coast-to-coast national network that’s
Dentist at the top of the page.
available when traveling outside of Florida. They’ll enjoy
2. In Step 1, Dentists Information, select the Type of the freedom of selecting a quality provider from more
Dentist. than 100,000 dentists nationally while still enjoying the
benefit of using an in-network provider.
3. Next, go to Step 2, Insurance Plan Information,
and choose Plan type from the drop-down menu. To see all the out-of-network provider options, go to
Be sure to select the full plan name of the dental FloridaBlueDental.com and click Find A Dentist at
plan being offered. Selecting the proper plan the top.
ensures that members search within their plan’s
network. Find a
Find a
Dentist
4. Next, go to Step 3, Location, and narrow the Dentist
selection by Zip Code/Distance, Street/City, or
County and click Search.
Note: BlueDental Care members must select a
general dentist for themselves and for each of their
covered dependents.
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BluesEnroll
EnrollPoint EnrollPoint offers your clients the following
advantages:
Florida Blue and FCL know that finding ways to be
more efficient is always a priority. That’s why we offer • A user-friendly system that simplifies the benefit
EnrollPoint. EnrollPoint is an online Florida Blue tool that administration process and saves time
allows organizations to quickly and efficiently manage • Access via a secure site – no need to download
their group’s benefits. With EnrollPoint, your groups can software
make changes from anywhere, eliminating the need to • Automation that removes guesswork from employee
mail paper forms. The site is designed to include your eligibility dates and plan eligibility
clients’ plan rules and provisions so they can make year- • Improved data accuracy by replacing error-prone
around changes to: paper applications
• Benefit changes that can be seen in real time
• New-hire benefit elections
• New-hire declinations Have Your Clients Enroll Today! It’s Easy.
• Terminations
• Life-event changes Your clients that are interested in using EnrollPoint
• Address changes should complete the Benefit Administrator
• Rehires Authorization Form located under the Employers
tab at FloridaBlue.com. Once the form is received, a
representative will contact them with details and
log-in information.
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Large Group Renewals/Commissions & Rewards
Large Group Renewals Commissions and Rewards
Renewals for large groups of 51 or more eligible Our compensation and bonus programs continue to
employees will be given to groups and agents by reflect our commitment to our valued sales partners.
Florida Blue sales representatives. Please contact your For more information about our various reward
sales representative when you need assistance or have and recognition programs, talk to your Florida Blue
questions regarding any renewal of FCL products. representative or contact the Agent Service Center at
800-267-3156. Don’t forget that sales of FCL ancillary
products – dental, life, and disability – count toward
your Florida Blue classification and in-force bonus,
helping to maximize your rewards.
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10Sales and Service Contacts
Contact Phone/Fax Address
Florida Blue Agent Service Center: (800) 267-3156
BlueDental Choice, Choice Plus, and Choice Copayment Plans
(888) 223-4892 - Members
Dental Customer Service (888) 224-4049 - Group N/A
Admin. and Agents
Electronic submissions: Payer ID: 76031
Paper submissions:
(888) 223-4892 - Members
Florida Combined Life
Claims (888) 224-4049 - Group
Dental Claims Department
Admin. and Agents
P.O. Box 1047
Elk Grove Village, IL 60009-1047
Enrollment/Membership
Florida Blue
(Applications for New Hires and (866) 946-2583
P.O. Box 44144
Change Forms) Fax: (904) 997-5471
Jacksonville, FL 32231
Remit all payments to:
Florida Combined Life
Dept. 1158
P.O. Box 121158
Dallas, TX 75312-1158
Billing Inquiries
(866) 946-2583
(Invoices and Payments) or Overnight:
Florida Combined Life
891158
1501 North Plano Road
Suite 100
Richardson, TX 75081
BlueDental Care Prepaid Plan
(877) 325-3979
Dental Customer Service Press 1 for member N/A
Press 4 for agent
Florida Combined Life
P.O. Box 211778
Billing/Payments (866) 537-0233 X 85702
Kansas City, MO 64121-1778
fclbilling@cbbcbsfl.com
Florida Combined Life
New Hires/Change Forms Fax: (904) 376-8425 P.O. Box 769569
Roswell, GA 30076-8223
Applications for new hires, enrollment additions, terminations, and changes should be included with the group’s invoices. Urgent additions,
terminations, changes, or billing questions may be emailed to fclbilling@cbbcbsfl.com. New hire applications not submitted with the invoice may be
faxed to the number above. Groups should note group number on the application.
BCBSFL SGEO
New Business Group Packages (4-50) N/A 4800 Deerwood Campus Parkway, DCC8-6
Jacksonville, FL 32246
Florida Blue, Florida Blue HMO, Florida Blue Preferred HMO (collectively, “Florida Blue”), Florida Combined Life and the Blue Cross
and Blue Shield Federal Employee Program (FEP) comply with applicable Federal civil rights laws and do not discriminate on the basis
®
of race, color, national origin, age, disability or sex.
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22194R-02.20 19D-FB-0310
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