Anthem Dental Complete

Benefits Network Non-Network
Annual Benefit Maximum                                                    Calendar Year
     - Per insured person
Annual Maximum Carryover

$1,000
No

$1,000
No
Orthodontic Lifetime Benefit Maximum
     - Per eligible insured person

$1,000

$1,000
Annual Deductible
     - Per insured person
     - Family maximum

$50
2x Individual

$50
2x Individual
Deductible Waived for Diagnostic/Preventive Services Yes Yes
Out-of-Network Reimbursement Options: 90th percentile

Dental Services

In-Network Anthem Pays: Out-of-Network Anthem Pays
Diagnostic and Preventive Services, for example:
     - Periodic oral exam
     - Teeth cleaning (prophylaxis)
     - Bitewing X-rays:   1x per 12 months
     - Intraoral X-rays
100% Coinsurance 100% Coinsurance
Basic Services
     Fillings, for example:
     - Amalgam (silver-colored)
     - Front composite (tooth-colored)
     - Back composite    Alternated to Amalgam Benefit
80% Coinsurance 80% Coinsurance
Basic or Major Services
     Crowns
     Prosthodontics, for example:

     - Dentures
     - Bridges
     - Dental implants     Not covered
     Prosthetic Repairs/Adjustments
     Endodontics, for example:
     - Root Canal
     Periodontics, for example:
     - Scaling and root planing
     Oral Surgery
Waiting Period for Basic Services: 
          No Waiting Periods
Waiting Period for Major Services:           No Waiting Periods

50% Coinsurance
50% Coinsurance



50% Coinsurance
80% Coinsurance

80% Coinsurance

80% Coinsurance
 

50% Coinsurance
50% Coinsurance



50% Coinsurance
80% Coinsurance

80% Coinsurance

80% Coinsurance
Orthodontic Services
     - Dependent Children Only*
Waiting Period:                          No Waiting Period

60% Coinsurance

60% Coinsurance
 
* Child orthodontic coverage begins at age eight and runs through age 18. This means that the child must have been banded between the ages of eight and 19 in order to receive coverage. If children are dependents until age 19, they can continue to receive coverage, but they must have been banded before age 19.

Finding a dentist is easy.
To select a dentist by name or location, do one of the following:
- Go to anthem.com/mydentalvision
- Call Customer Service at the toll-free number listedon the back of your dental ID card

 

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