Dental
| The OPEH&W Health Plan’s Plan Year runs from July 1, 2019 through June 30, 2020. |
| Rates and Coverage details are per plan year unless stated otherwise and are valid July 1, 2019 through June 30, 2020. |
| Rates shown are for Active Employees. |
| On this Page | |
| 》 | Resources |
| 》 | Rates |
| 》 | Coverage Details |
| 》 | Coverage Highlights |
| 》 | Preventive & Diagnostic Benefits |
| 》 | Basic Services |
| 》 | Major Services |
| 》 | Orthodontic Benefits |
| 》 | Video |
| Resources | ||
| Coverage Highlight (One Page) | 》Download | |
| Dental Out-of-Network Claim Form | 》Download | |
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| Premium Rates | ||
| Monthly for Active Employees | ||
| Member | $42.36 | |
| Child | $22.82 | |
| Children | $36.28 | |
| Spouse | $53.36 | |
| Spouse & Child | $76.18 | |
| Spouse & Children | $89.64 | |
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| Coverage Details | |||
| Vendor | BlueCross BlueShield of Oklahoma | ||
| Website | 》www.bcbsok.com | ||
| Member Support | 888.381.9727 | ||
| Network | Dental Network of American (DNoA) | ||
| Network Support | 800.972.7565 | ||
| Provider Search | 》Search | ||
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| Coverage Highlights | |||
| Plan Paid Maximum | $1,500 | ||
| Deductible | $50 | ||
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| Preventive & Diagnostic Services | |||
| Co-Insurance | 0% | ||
| How it Works | Plan pays 100% of covered services 2 times per plan year, not subject to deductible. | ||
| Covered Services | Includes but not limited to: Cleaning, Polishing, Bite-Wings X-Rays & Prophylaxis | ||
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| Basic Services | |||
| Co-Insurance | 20% | ||
| How it Works | After meeting deductible member pays 20% co-insurance of covered Basic Services until the Plan Paid Maximum has been met, after which member pays 100% of claims costs for the remainder of the plan year. | ||
| Covered Services | Includes but not limited to: Fillings, Simple Extractions, Surgical Removal of Teeth & Root Canals | ||
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| Major Services | |||
| Co-Insurance | 50% | ||
| How it Works | After meeting deductible member pays 50% co-insurance of covered Major Services until the Plan Year Plan Paid Maximum has been met, after which member pays 100% of claims costs for the remainder of the plan year. | ||
| Covered Services | Includes but not limited to: Crowns, Full or Partial Dentures, Bridge Repairs & Occlusal Guards | ||
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| Orthodontic Services | |||
| Co-Insurance | 50% | ||
| How it Works | Member pays 50% co-insurance of covered Orthodontic Services for Dependent Children up to age 26, until the Lifetime Maximum of $1,500 has been met, after which member pays 100% of claims costs. | ||
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| Video | ||
| 》 | Videos are best viewed in full screen mode. To enter full screen mode, first hit play, then click the icon in the lower right of the video pane which looks like a square with gaps in each side | |
| 》 | Having trouble viewing in-page videos, then use the following direct YouTube link | |
| Dental Benefits 》http://youtu.be/f_dAPbr-wz4 | ||
| 》Top of Page | ||