Dental Plan Comparison

At a Glance Comparison: HMO vs. PPO,  effective 7/1/14 ​www.anthem.com/ca


​Plan Name

 Blue Cross Dental Net

2700 DHMO

HMO Plan Summary

Blue Cross Modified Dental Blue Plan 6
Network 100 PPO

PPO Plan Summary

Plan Features​

​Choice of dentist from Anthem's network

No deductible.  Co-pays

for some services.

 ​Choice of any dentist.  Self-referral to specialists.  PDP fee refers to the fees that participating PPO dentists have agreed to accept as payment in full. Non-PPO benefits based on percentage of UCR.

Annual Benefit Maximum

​Unlimited

 

​$2,000 per person
Deductible (calendar year)​None
$25 Individual / $75 Family
(waived for diagnostic & preventive services)
PPO Non-PPO

Diagnostic & Preventive

 (Type A)​

Limited to 2/year

​100% for diagnostic; $10-$25 copay for sealants and space maintainers

​90% of PDP ​90% UCR
Basic Services (Type B)​Various co-payments​90% of PDP ​90% UCR
Major Services (Type C)​ ​Various co-payments​80% of PDP

​80% UCR

Orthodontia​ Child & Adult: $1450 (additional charges apply for Pre-Ortho treatment plan and retention) ​Not covered ​Not covered
  1. District Provided Coverage for retirees over age 65 and their dependents enrolled in the Blue Cross PPO plan terminates on  June 30th following the retiree's 65th birthday. Retirees may purchase PPO Dental by paying full premium.  Blue Cross DHMO Dental benefits continue beyond age 65.
  2. Dental cleanings under Blue Cross must not exceed two per year to be considered eligible for payment.
  3. Dentures & Bridgework replacement by Blue Cross: one every 5 years (PPO Plan).
  4. Crowns/Inlays/Onlays replacement by Blue Cross: once every 5 years  (PPO Plan)
  5. If a course of treatment is estimated to cost $300 or more, it is strongly recommended that your dentist obtain a predetermination of benefits from Blue Cross.

The information contained in this summary is intended to provide a general idea of the benefits of each of the health plans offered by Rancho Santiago Community College District.  Actual benefits are determined by the applicable provisions of the respective plan's contract.  There may be conditions or exclusions that modify items in this summary.  In the event of any discrepancy between this summary and the provisions of the specific insurance contracts, the provisions of the contracts shall apply.