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Oregon Medical Insurance > Regence BlueCross BlueShield of Oregon > Dentacare Rates & Benefits

Providence Health Plans

Monthly Individual Dentacare Prices (optional)
Age
Individual
Individual & Spouse
One Adult
& Child(ren)
Family
0-17
$23
N/A
N/A
N/A
18-60+
$23
$46
$45
$68
Note: Individual Dentacare must be purchased in conjunction with one of the Regence Blue Selections health insurance plans.
Benefit Features
Choice of providers Willamette Dental
Deductible per calendar year No deductible
Maximum benefit per calendar year No maximum benefit
Office visit charge $15 per visit
Services subject to office visit charge:

Routine and emergency exams

Fully covered after visit charge

Bitewing x-rays

Fully covered after visit charge

Cleanings for adults and children

Fully covered after visit charge

Flouride treatment for children through age 12

Fully covered after visit charge

Head and neck cancer screening

Fully covered after visit charge

Oral hygiene instruction

Fully covered after visit charge

Periodontal Screen

Fully covered after visit charge

Periodontal Maintenance

Fully covered after visit charge
Services subject to additional service fee of percentage:

Sealant per quadrant

$20 service fee after visit charge

After hours visits

$20 service fee after visit charge

Panoramic x-rays

$20 service fee after visit charge

Restorative fillings, amalgam, or anterior composite

$30 service fee after visit charge

Simple extractions

$30 service fee after visit charge

Simple denture/partial repairs

$30 service fee after visit charge

Other dental services

20% discount after visit charge
Orthodontia Services: (Provided only through Willamette Dental)

Pre-orthodontia service fee
(credited toward comprehensive orthodontia fee if patient accepts treatment plan)

$150 after visit charge

Comprehensive orthodontia fee (no age limit)

$2,600 after visit charge
Miscellaneous Services:

Local anesthesia (Novocain)

Fully covered

Nitrous oxide (per visit fee)

$10

Fee for missed appointments

$30
Please note: There is a six-month waiting period for major services which includes crowns, bridges, partials, and dentures.

As a new patient of Willamette Dental, you can expect your first visit to include:

  • discussion of your medical and dental history
  • necessary x-rays, a thorough examination, and the development of your treatment plan
  • review of causes of decay, gum disease, and a demonstration of effective methods of brushing and flossing
  • a cleaning along with flouride and decay reducing treatment up to age 12
  • the scheduling of a cleaning appointment for adults
Dental Limitations and Exclusions
Once enrolled, your contract can be viewed online at www.or.regence.com.  Please refer to your contract for a complete list of benefits and the limitations and exclusions that apply.

These Benefits Are Limited

  • We will not duplicate benefits for which you are eligible under Medicare except as required by law.
  • We will not cover the replacement of an existing denture, crown, or brider less than seven years after the date of the most recent placement. We will not cover a denture replacement made necessary by loss, theft, or breakage.
  • The benefits of this plan are not subject to any coordination of benefits provision.

Services And Supplies Not Covered

  • Services or supplies you receive before your coverage starts or after your coverage ends.  The date artificial teeth are prepared is considered as the date of service.
  • Services that are not necessary dental care.
  • Services and supplies related to the diagnosis or treatment of temporomandibular joint.
  • Dental Implants
  • Lost, stolen, or broken appliances
  • Splints, nightguards, and other appliances used to indrease vertial dimensions, restore bite, or correct habits such as toungue thrusting or teeth grinding.
  • Treatment(s), procedures, equipment, medications, devices, and supplies that are experimental or investigational even when provided by foreign providers.
  • Services or supplies not received from a Willamette Dental dentist (except as specifically listed).
  • Surgery for fractures, cysts, or tumors.
  • Models of teeth and surrounding tissue for purposes of study and treatment planning.
  • Services provided by a dentist or denturist that are beyond the scope of his or her license.
  • Cosmetic dental services including complications arising out of such services.
  • General anesthesia, unless recommended by the referring or attending dentist for a medical condition which requires general anesthesia before services can be performed.
  • Recording of jaw movements or positions.
  • Services or supplies you receive from a dental or medical department maintained by or on behalf of any employer, or mutual benefit association, labor union, trustee, or similar person or group.
  • Services and supplies not specifically listed.

 

 

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