Dental Plan - BCBS Calendar Year Benefit Maximum: $1,500 per family member Dental Blue Freedom In Network Out-of-Network Calendar Year Deductible Per Member $50 Family Maximum $150 Preventive & Diagnostic Care (Deductible is waived for these services) 100% Coverage 80% Coverage Cleanings, Exams Basic Services Fillings, Extractions 80% Coverage 60% Coverage Major Services Crowns, Implants, Dentures 50% Coverage 30% Coverage Orthodontia Services NEW (No Deductible & does not count towards Calendar Year Maximum) 100% Coverage 80% Coverage $2,000 Lifetime Maximum per family member DENTAL 2022-2023 2023-2024 Bi-Weekly Change from Bi-Weekly Rate Bi-Weekly Rate 2022-2023 Individual $14.77 $15.51 $0.74 Family $36.46 $38.28 $1.82 Find a dentist at bluecrossma.org 24