97176LA0390001 |
Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0400001 |
Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0400001 |
Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0390001 |
Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0400002 |
Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0400002 |
Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0390002 |
Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0390002 |
Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0400003 |
Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0400003 |
Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0390003 |
Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/60%/50% coinsurance, $0 deductible |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0390003 |
Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/60%/50% coinsurance, $0 deductible |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0340017 |
Blue Max 70/50 $6700 |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0340017 |
Blue Max 70/50 $6700 |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0340015 |
Blue Max 90/70 $1500 |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0340015 |
Blue Max 90/70 $1500 |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0340010 |
Blue Max Copay 50/50 $3300 |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0340010 |
Blue Max Copay 50/50 $3300 |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0340024 |
Blue Max Copay 50/50 $7500 Standardized Plan |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0340024 |
Blue Max Copay 50/50 $7500 Standardized Plan |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0340023 |
Blue Max Copay 60/40 $5900 Standardized Plan |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0340023 |
Blue Max Copay 60/40 $5900 Standardized Plan |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0340022 |
Blue Max Copay 75/55 $1500 Standardized Plan |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0340022 |
Blue Max Copay 75/55 $1500 Standardized Plan |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0350004 |
Blue Saver 60/40 $6100 |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0350004 |
Blue Saver 60/40 $6100 |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0350003 |
Blue Saver 90/70 $3400 |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0350003 |
Blue Saver 90/70 $3400 |
2025 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 13, 2024 |
97176LA0390001 |
Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0400001 |
Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0400001 |
Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0390001 |
Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0400002 |
Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0390002 |
Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0390002 |
Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0400002 |
Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0400003 |
Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0400003 |
Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0390003 |
Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/60%/50% coinsurance, $0 deductible |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0390003 |
Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/60%/50% coinsurance, $0 deductible |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0340021 |
Blue Max 100/100 $9450 |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0340021 |
Blue Max 100/100 $9450 |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0340017 |
Blue Max 70/50 $6700 |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0340017 |
Blue Max 70/50 $6700 |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0340015 |
Blue Max 90/70 $1500 |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0340015 |
Blue Max 90/70 $1500 |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0340010 |
Blue Max Copay 50/50 $3300 |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0340010 |
Blue Max Copay 50/50 $3300 |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0340024 |
Blue Max Copay 50/50 $7500 Standardized Plan |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0340024 |
Blue Max Copay 50/50 $7500 Standardized Plan |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0340023 |
Blue Max Copay 60/40 $5900 Standardized Plan |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0340023 |
Blue Max Copay 60/40 $5900 Standardized Plan |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0340022 |
Blue Max Copay 75/55 $1500 Standardized Plan |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0340022 |
Blue Max Copay 75/55 $1500 Standardized Plan |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0350004 |
Blue Saver 60/40 $6100 |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0350004 |
Blue Saver 60/40 $6100 |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0350003 |
Blue Saver 90/70 $3400 |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0350003 |
Blue Saver 90/70 $3400 |
2024 |
NOT APPLICABLE [PCP] [Dentist]
|
Oct 27, 2023 |
97176LA0400001 |
Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0390001 |
Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0390001 |
Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0400001 |
Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0390002 |
Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0390002 |
Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0400002 |
Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0400002 |
Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0400003 |
Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0400003 |
Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0390003 |
Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/60%/50% coinsurance, $0 deductible |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0390003 |
Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/60%/50% coinsurance, $0 deductible |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0340021 |
Blue Max 100/100 $9100 Standardized Plan |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0340021 |
Blue Max 100/100 $9100 Standardized Plan |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0340017 |
Blue Max 70/50 $6700 |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0340017 |
Blue Max 70/50 $6700 |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0340015 |
Blue Max 90/70 $1500 |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0340015 |
Blue Max 90/70 $1500 |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0340010 |
Blue Max Copay 50/50 $3200 |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0340010 |
Blue Max Copay 50/50 $3200 |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0340023 |
Blue Max Copay 60/40 $5800 Standardized Plan |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0340023 |
Blue Max Copay 60/40 $5800 Standardized Plan |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0340022 |
Blue Max Copay 75/55 $2000 Standardized Plan |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0340022 |
Blue Max Copay 75/55 $2000 Standardized Plan |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0350004 |
Blue Saver 60/40 $6100 |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0350004 |
Blue Saver 60/40 $6100 |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0350003 |
Blue Saver 90/70 $3200 |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0350003 |
Blue Saver 90/70 $3200 |
2023 |
NOT APPLICABLE [PCP] [Dentist]
|
Sep 16, 2022 |
97176LA0390001 |
Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0400001 |
Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0400001 |
Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0390001 |
Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 deductible |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0390002 |
Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0390002 |
Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0400002 |
Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0400002 |
Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0400003 |
Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0400003 |
Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0390003 |
Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/60%/50% coinsurance, $0 deductible |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0390003 |
Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/60%/50% coinsurance, $0 deductible |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0340017 |
Blue Max 70/50 $6700 |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0340017 |
Blue Max 70/50 $6700 |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0340015 |
Blue Max 90/70 $1500 |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0340015 |
Blue Max 90/70 $1500 |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0340010 |
Blue Max Copay 60/40 $3000 |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0340010 |
Blue Max Copay 60/40 $3000 |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0350004 |
Blue Saver 60/40 $6100 |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0350004 |
Blue Saver 60/40 $6100 |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0350003 |
Blue Saver 90/70 $3100 |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |
97176LA0350003 |
Blue Saver 90/70 $3100 |
2022 |
NOT APPLICABLE [PCP] [Dentist]
|
Aug 19, 2021 |