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WHO IS ELIGIBLE FOR BLUE CROSS DENTAL PLANSYou and your dependent must be California resident. If you enroll in one of the Blue Cross Dental SelectHMO plans, you and your dependents must select the same particiapating dental office. Dental providers and locations are different for the Dental PPO and Dental SelectHMO. Eligible dependents include:
|
Dental PPO Plan (7874) from BC life & Health Insurance Company | |||||||||
Area 1 |
Area 2 |
Area 3 |
Area 4 |
Area 5 |
Area 6 |
Area 7 |
Area 8 |
Area 9 |
|
| Subscriber | $ 39.00 | $ 36.00 | $ 337.00 | $ 41.00 | $ 43.00 | $ 41.00 | $ 37.00 | $ 40.00 | $ 43.00 |
| Subscriber & Spouse | $ 77.00 | $ 69.00 | $ 70.00 | $ 80.00 | $ 83.00 | $ 80.00 | $ 71.00 | $ 78.00 | $ 84.00 |
| Subscriber & Child | $ 61.00 | $ 56.00 | $ 57.00 | $ 64.00 | $ 67.00 | $ 64.00 | $ 57.00 | $ 62.00 | $ 67.00 |
| Subscriber & Children | $ 93.00 | $ 86.00 | $ 87.00 | $ 99.00 | $ 104.00 | $ 99.00 | $ 88.00 | $ 96.00 | $ 104.00 |
| Family | $118.00 | $108.00 | $111.00 | $127.00 | $132.00 | $127.00 | $112.00 | $122.00 | $132.00 |
| 1 Child | $ 32.00 | $ 29.00 | $ 29.00 | $ 34.00 | $ 35.00 | $ 34.00 | $ 29.00 | $ 33.00 | $ 35.00 |
| 2 Children | $ 61.00 | $ 56.00 | $ 56.00 | $ 64.00 | $ 66.00 | $ 64.00 | $ 57.00 | $ 62.00 | $ 66.00 |
| 3+ Child | $ 87.00 | $ 79.00 | $ 80.00 | $ 90.00 | $ 95.00 | $ 90.00 | $ 81.00 | $ 88.00 | $ 95.00 |
Area 1 Counties |
Area 2 Counties |
Area 3 Counties |
Area 4 Counties |
Area 5 Counties |
Area 6 Counties |
Area 7 Counties |
Area 8 Counties |
Area 9 Counties |
Del Norte |
Alpine* |
Alameda |
Orange, |
Los Angeles (except ZIP codes beginning with 906-912, 915, 917, 918 & 935) |
Imperial Riverside (except ZIP code 92883) |
Kern |
San Luis Obispo (except ZIP code 93426) |
Los Angeles (ZIP codes beginning with 906-12, 915, 917, 918 & 935) |
*If you live in a county with an asterisk(*), please contact your Blue Cross respresentative, agent or broker | ||||||||
Dental SelectHMO Plans from Blue Cross of California | ||||
Blue Cross Dental Saver SelectHMO |
Blue Cross Dental SelectHMO |
Blue Cross Dental Premier SelectHMO |
Note: Blue Cross Dental SelectHMO is available
in these counties: Alameda, Contra Costa, Los Angeles, Marin, Orange, Sacramento, San Diego, San Francisco, San Joaquin, San Luis Obispo,
Santa Barbara, Santa Clara, Solano, and Sonoma. | |
Single |
$ 10.00 | $ 14.50 | $ 18.00 | |
Two-Party |
$ 20.00 | $ 29.00 | $ 35.50 | |
Family |
$ 30.00 | $ 43.50 | $ 53.50 | |