2024-2025 Benefits Guide

Out-of-Network Coverage One of the differences between the two plans is how out-of-network expenses are covered. The 100/60 Plan reimburses out-of-network expenses based on the Maximum Allowable Charge (MAC), which is typically lower and may mean you pay more out-of-pocket. In contrast, the 80/60 Plan reimburses up to the 90th percentile of the Usual, Customary, and Reasonable (UCR) rates, usually resulting in higher reimbursements and lower out-of-pocket costs for out-of-network services. Therefore, if your dentist is in-network or you are open to finding a new in- network dentist, then the 100/60 plan offers higher coverages. Blue Care Dental Connection

As an enhanced service, Blue Cross and Blue Shield of Texas (BCBSTX) offers BlueCare Dental Connection. This service provides educational information and other resources to help you make choices about your dental care – at no extra cost. To help you learn about good oral health, BlueCare Dental Connection offers: • Educational mailings

• 24-hour online access to the Dental Wellness Center, which offers educational articles and special tools. To access the Dental Wellness Center, log in to Blue Access for Members at bcbstx.com and select the Wellness tab on the dashboard. Scroll down to the Dental Wellness Center section, and click the button. The Dental Wellness Center allows you to: • Ask dental questions through Ask a Dentist • Locate an in-network dentist using Find a Dentist • Research dental fees in your area with the Dental Cost Advisor • Search the Dental Dictionary for common dental terms • View videos on various dental topics in the Educational Videos section

Employee Bi-Weekly Cost

Premiums are the same for both plans. Employee- only dental coverage is provided at no cost to employees. However, if you choose to add dependents, you will be responsible for the additional premium costs. Please refer to the table on the left to view the monthly and bi-weekly costs.

Employee Monthly Cost

Dental Rates

Employee Only

$0.00

$0.00

Employee + Spouse Employee + Child(ren) Employee + Family

$29.65 $51.99 $93.23

$14.83 $26.00 $46.65

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