Dental
Jim Ellis offers a comprehensive dental plan with an extensive network of dentists through Anthem. We encourage you to use network dentists in order to help manage the long term costs of the dental plan and reduce your out-of-pocket costs.
The Anthem dental plan provides coverage both in and out-of-network. However, you will make the most of your dental plan benefits if you visit participating Anthem dentists. We encourage you to use a participating dental provider to reduce your out-of-pocket costs and help manage the long term costs of the plan. Participating dentist information can be found on the Resources page.
Below is a benefit summary of your annual deductible and co-insurance costs.
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Calendar Year Deductible
|
$50 individual | $150 Family
Does not apply to preventive or orthodontic care |
|---|---|
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Calendar Year Maximum
|
$5,000 |
|
Orthodontia: Children to age 19 only
|
Plan pays 50%
$1,000 lifetime maximum |
|
Preventive Care (Deductible Waived):
|
Plan pays 100%
Exams and cleanings: 2 per 12 months Fluoride: 2 per 12 months (children under age 16) Bitewing x-rays: Oner per calendar year Full mouth x-rays: Once per 5 years Bitewing x-rays: Once per calendar year Full mouth x-rays: Once per 3 years |
|
Type B - Basic Services (After Deductible):
|
Plan pays 80%
Sealants: Once per 3 years (children under age 16) Space maintainers: Once per 5 years (under age 16) Amalgam and composite fillings: once per tooth per 2 years |
|
Type C - Major Services (After Deductible):
|
Plan pays 50%
Oral surgery: Simple and surgical extractions Root canal Periodontal maintenance and surgery Scaling and root planing Crowns, dentures, and fixed bridges Inlays / Onlays Implant services |
| Please refer to the Certificate for a completing listing of covered services and frequency limitations. |
Important Notes
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No age limitations for coverage
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$50 employee deductible / $150 family deductible (waived for preventive and orthodontic care)
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100% Preventive Coverage / 80% Basic Coverage / 50% Major Services
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Members utilizing participating dentists will enjoy discounted dental fees in addition to protection from balance billing for charges above the dentist’s maximum allowable charges. Members utilizing non-participating dentists will have the same benefits but may be subject to balance billing.
Finding a Provider
Access www.anthem.com and select "Find a Doctor." Select “Dental” for type of care, and then select “Georgia” in the drop down. Select “Dental” for the type of plan, and then “Dental Complete” for the plan / network.
Claims Process
In-Network
- Participating dentists file the claim and accept payment from Anthem
- Employees should not need to pay at the time of service for participating providers
Out-of-Network
- For out-of-network dentists, if the dentist does not agree to file the claim as out-of-network with Anthem, employee pays at the time of service and files a claim for reimbursement
- Charges by out-of-network providers that exceed Usual & Customary charges are the member’s financial responsibility. (Member pays the difference between the actual charge and the plan’s U&C reimbursement level.)
