Your Dentist Dental Blue Freedom offers a large network of dentists, including participating dentists in Massachusetts and nationwide. When searching for a network dentist, Dental Blue Freedom members can choose from the Dental Blue PPO (Preferred Dentist) or Dental Blue (Participating Dentist) networks. Using a network dentist will minimize your out-of-pocket expenses. If you would like help choosing a dentist, or already have a dentist and want to know if they participate with your plan, you can call the dentist, look at the current dental provider directory, or call Member Service at the toll-free phone number shown on your Dental Blue ID card. You can also access the online dental provider directory at bluecrossma.org. Your Benefits You will receive the greatest value if you visit a preferred dentist, because you will maximizetheamountofbenefitsreceivedunderyourplan. Thedentalbenefitsyourplancoversaresubjecttothecalendar-yeardeductible andcoinsurance(ifapplicable),andbenefitmaximumamountsshowninthe chart. For members under age 13, these benefits (not including orthodontic services) are covered in full up until the calendar-year benefit maximum. The calendar year begins on January 1 and ends on December 31 of each year. The chart also shows the percentage of costs your plan will pay for covered dental services.Manyofthecoveredserviceshavespecifictimeoragelimits. Pre-Treatment Estimates If your dentist expects that your dental treatment will involve covered services that will cost more than $250, Blue Cross Blue Shield recommends that your dentist send a copy of the “treatment plan” to Blue Cross Blue Shield before services are provided. A treatment plan is a detailed description of the procedures that the dentist plans to perform and includes an estimate of the charge for each service. Once the treatment plan is reviewed, you and your dentistwillbenotifiedofthebenefitsavailable. Remember, the payment estimate is based on your eligibility status and the amountofyourcalendar-yearorlifetimebenefitmaximumatthetimethe estimate is received and reviewed. (The actual payment may differ if your availablecalendar-yearorlifetimebenefitmaximumoreligibilitystatus has changed.) Multi-Stage Procedures Yourdentalplanprovidesbenefitsformulti-stageprocedures(proceduresthat require more than one visit, such as crowns, dentures and root canals) as long as you are enrolled in the plan on the date that the multi-stage procedure is completed. A participating dentist will send a claim for a multi-stage procedure to Blue Cross Blue Shield only after the completion date of the procedure. You will be responsible for all charges for multi-stage procedures if your plan has been cancelled before the completion date of the procedure. How Network Dentists Are Paid - Preferred Dentists You will receive the greatest value if you visit a preferred dentist, because you will maximizetheamountofbenefitsreceivedunderyourplan. Payments are calculated based on the provisions of the Blue Cross Blue Shield preferred dentist’s payment agreement and the dentist’s allowed charge that is in effect at the time the covered dental service is provided. Preferred dentists agree to accept the allowed charge as payment in full. You pay your deductible and coinsurance (if applicable), and any allowed charges beyond your calendar-year orlifetimebenefitmaximum. How Network Dentists Are Paid - Participating Dentists For dentists who participate with Blue Cross Blue Shield, but do not have a BlueCrossBlueShieldpreferredprovidercontract,benefitsarecalculatedbased on the provisions of the participating dentist’s payment agreement and the dentist’s allowed charge. These dentists agree to accept the allowed charge as payment in full. You pay your deductible and coinsurance (if applicable), and any allowedchargesbeyondyourcalendar-yearorlifetimebenefitmaximum. How Out-of-Network Dentists Are Paid - Non-Preferred or Non-Participating Dentists Benefitsforcoveredservicesbyanon-preferredornon-participatingdentistare provided based on the allowed charge or the dentist’s actual charge, whichever is less. The allowed charge is based on a schedule of charges. You may be responsible for any difference between the dentist’s actual charge or the allowed charge, whichever is less. You are also responsible for your deductible and coinsurance (if applicable), and charges beyond your calendar-year or lifetime benefitmaximum. Orthodontic Benefits Yourplanincludesorthodonticcoverage.Thelifetimebenefitmaximumisnot partofyourcalendar-yearbenefitmaximum;itappliesonlytoorthodontic services. You are responsible for your coinsurance (if applicable) and any charges beyondyourlifetimebenefitmaximum.Benefitsareavailableonyoureffective date. If your orthodontic treatment began before you were covered under Dental Blue Freedom, a monthly fee will be paid for your remaining orthodontic visits untileitheryourtreatmentiscompletedorthelifetimebenefitmaximumis exhausted,whichevercomesfirst. Welcome to Dental Blue freedom, A DENTAL PLAN DESIGNED TO MANAGE THE COST OF DENTAL SERVICES.