Dental Blue Freedom Plan
This is a unique dental plan, designed especially for BU employees who may not be able to conveniently receive all their dental care services at the BU Dental Health Centers. It provides you three choices of dental providers; you decide where to receive treatment each time you need dental care. You have access to providers at the BU Dental Health Centers; Blue Cross Blue Shield dental network providers (look under the Dental Blue network); or you may choose your own provider. Plan benefits vary based on where you receive care.
|
Service |
Coverage at Centers* |
BCBS Dental Blue & PPO (in Massachusetts) Network** |
BCBS Dente Max (National) Network** |
Out of Network Provider*** |
| Deductible | None | $50 per person | $50 per person | $50 per person |
| Preventive & Diagnostic | 100% | 80%, no deductible | 80%, no deductible | 80%, no deductible |
| Basic Restorative | 80% | 60%, after deductible | 60%, after deductible | 60%, after deductible |
| Major Restorative | 50% | 40%, after deductible | 40%, after deductible | 40%, after deductible |
| Orthodontics | 50% ($2,000 per person, lifetime maximum) | Not covered | Not covered | Not covered |
| Annual Maximum | $1,700 per person**** | |||
- *Based on the BU Dental Health Center Table of Allowance
- **Based on the lesser of either the dentist’s actual charge or the allowed charge. If your provider is in the Dental Blue PPO network, your share of the cost of services may be less than if your provider is in only the Dental Blue Network. To determine which networks your provider participates in, review your provider’s profile on the Blue Cross website search for a provider.
- ***Based on the actual charge or the allowed 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.
- ****Maximum applies to claims paid for any BCBS dental plan in the same calendar year.