Blue Cross Dental Individual & Family Plan Highlights
Blue Cross dental plans Value Plans Preferred Freedom
Standard Enhanced Premium
Advantage Plus 2.0 Network In/Out of Network In/Out of Network In/Out of Network In Network Out of Network In/Out of Network
Contract year deductible
(per person/per family)
$0 $50/$150
(Excludes services covered at 100%)
$0 $50
(Excludes services covered at 100%)
$50
(Excludes services covered at 100%)
$50
(Excludes services covered at 100%)
Annual maximum per member $1,000 $1,000 $1,000 $1,000 $1,000 $1,500
Preventive and diagnostic Waiting period
Exams NONE 100% 100% 100% 100% 80% 100%
X-Rays NONE 100% 100% 100% 100% 80% 100%
Cleanings NONE 100% 100% 100% 100% 80% 100%
Fluoride treatments NONE 100% 100% 100% 100% 80% 100%
Sealants NONE Not covered 100% 100% 100% 80% 100%
Palliative treatment NONE Not covered 60% 50% 100% 80% 100%
Basic treatment Waiting period
Basic restorative 6 months Not covered 60% 50% 80% 60% 80%
Space maintainers 6 months Not covered 100% 100% 80% 60% 80%
Surgical/non-surgical periodontics 12 months Not covered Not covered Not covered 80% 60% 50%
Endodontics 12 months Not covered 60% 50% 80% 60% 50%
Simple extractions 6 months Not covered 60% 50% 80% 60% 80%
Complex oral surgery 12 months Not covered Not covered 50% 80% 60% 80%
General anesthesia 12 months Not covered Not covered 50% 80% 60% 80%
Repairs 6 months Not covered Not covered 50% 80% 60% 80%
Major treatment Waiting period
Inlays, onlays, crowns 12 months Not covered Not covered Not covered 50% 50% 50%
Prosthetics 12 months Not covered Not covered Not covered 50% 50% 50%
TMD 12 months 50% 50% 50% 50% 50% 50%
Enrollment in Blue Cross Dental plans can be done at any time. Coverage is generally effective the first of the month following receipt of the application.
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.