Plan Summaries can be found in the Employee Guide to Benefits

Preexisting Conditions
A pre-existing condition exclusion will apply to expenses involving the replacement of teeth that were missing prior to the effective date of the dental contract. This exclusion will not apply to:

• Any participant who becomes effective on the dental contract date who was covered under a previous group dental care contract by the Employer.
• Any participant who has been continuously covered for 24 months under a group dental care contract with BlueCross BlueShield of Oklahoma which included prosthetic benefits.

   

Limitations
When the course of treatment will be in excess of $300, a predetermination request should be submitted to BlueCross BlueShield of Oklahoma in advance of treatment.

• Low Plan Option
  When seeing a Non-Contracting Dentist, your out-of-pocket cost will be greater because Non-Contracting Dentists have not entered into a contract with BlueCross BlueShield of Oklahoma to accept any Allowable Amount determination as payment in full for Eligible Dental Expenses. Claims will be reimbursed at the Maximum Allowable Charge (MAC). You are required to file claim forms. You are balance billed for costs exceeding the BlueCross BlueShield of Oklahoma Allowable Amount.
• High Plan Option
  When seeing a Non-Contracting Dentist, your out-of-pocket cost will be greater because Non-Contracting Dentists have not entered into a contract with BlueCross BlueShield of Oklahoma to accept any Allowable Amount determination as payment in full for Eligible Dental Expenses. Claims will be reimbursed at the 90th percentile. You are required to file claim forms. You are balance billed for costs exceeding the BlueCross BlueShield of Oklahoma Allowable Amount.