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(877)566-5454 Toll Free
SIDE-BY-SIDE OVERVIEW COMPARISON OF THE PLANS
PRIME PLAN A
PRIME PLAN B
PRIME PLAN C
In & out of network
In & out of network
In & out of network
Annual Deductible None $50 $50
Annual Maximum $500 $1,000 $1,250
DIAGNOSTIC & PREVENTIVE SERVICES - No waiting period for exams, cleanings & X-rays
Exams 100% 100% 100%
Cleanings 100% 100% 100%
X-rays 100% 100% 100%
Sealants 100% 100% 100%
Fluoride treatments 100% 100% 100%
BASIC SERVICES - 6 month waiting period for basic services
Amalgum fillings (silver) Not covered 80% 80%
Space maintainers Not covered 80% 80%
Basic tooth extractions Not covered 80% 80%
Brush biopsy Not covered 80% 80%
Emergency palliative treatment Not covered 80% 80%
COMPLEX AND MAJOR SERVICES - 12 month waiting period for major services
Endodontic therapy Not covered 50% 50%
Periodontal (gum) services Not covered 50% 50%
Complex Oral Surgery Not covered 50% 50%
Major restorative services
(replacing natural teeth)
Not covered Not covered 50%
Prosthetic services
(dentures, partials & bridges)
Not covered Not covered 50%
Prosthetic repairs Not covered Not covered 50%
Orthodontics Not covered Not covered Not covered
VISION CARE SERVICES
BENEFIT FREQUENCY
NETWORK SERVICES
NON-NETWORK REIMBURSEMENT
Eye Exam (with dilation as needed) Once every 12 months $20 copay Up to $30
Standard plastic (CR39) lenses Once every 24 months    
Single Vision   $20 copay Up to $25
Bifocal   $20 copay Up to $40
Trifocal (FT25-28)   $20 copay Up to $55
Contact lenses Once every 24 months    
Elective (conventional and disposable)   $80 allowance Up to $60
Non-elective   Covered in full Up to $210
Frames Once every 24 months $130 allowance Up to $45
DENTAL BENEFIT POLICY Prime Plan A Benefit Policy Prime Plan B Benefit Policy Prime Plan C Benefit Policy
OUTLINE OF COVERAGE Plan A Outline of Coverage Plan B Outline of Coverage Plan C Outline of Coverage
CALIFORNIA BROCHURE with PRICING California Prime Dental & Vision Plans Brochure with Pricing
APPLICATION Prime Dental & Vision Plans - PRINT & MAIL Application
APPLY ONLINE Prime Dental & Vision Plans - APPLY ONLINE

Dental rates and plans apply to members from age 18 to under age 65 and are subject to change.
Annual rates reflect a 5% discount when pre-paying annually.


California Anthem Blue Cross Prime Dental Plans


Anthem Blue Cross Dentist Database

Prime Dental CLAIM FORM

Anthem Blue Cross Vision Database


Or you can fill in this form to have your Anthem Blue Cross Dental Prime Plans Insurance brochure with pricing & application mailed to you. Further information on our plans is shown below. Or just call us Toll-free at 877-Look4Life (877-566-5454).
Anthem Blue Cross PPO Dental Insurance Coverage Requested
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(under age 65)
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Dental HMO (Dental Health Maintenance Organization) plans also referred to as pre-paid plans, require you to choose one dentist or dental facility to coordinate all of your oral health needs. If you need to see a specialist, your primary care dentist will refer you; specialty care may require preauthorization. A typical DHMO-type plan doesn't have any deductibles or maximums. Instead, when you receive a dental service, you pay a fixed dollar amount for the treatment (a "copayment"). Often, diagnostic and preventive services have no copayment, so you pay nothing for these services. However, generally if you visit a dentist outside of the network, you may be responsible for the entire bill. Typically, the least expensive of dental plans.

Dental PPO (Dental Preferred Provider Organization) plans offer a network feature and usually offer a balance between lower costs and dentist choice. PPO dentists participate in the network thereby agreeing to accept contracted fees as payment in full rather than their usual fee for patients with the PPO. When you visit a PPO dentist, you typically pay a certain percentage of the reduced rate (called coinsurance) and the plan pays the rest. The percentage usually varies by the type of coverage such as diagnostic and preventive, major services. While you typically have the lowest out-of-pocket costs if you visit a PPO dentist, the plan allow you to visit the dentist of your choice, even if they are not in the network. Typically, the most expensive of dental plans.

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276 N El Camino Real #6, Oceanside, CA 92058
Phone:   (760) 433-0300    |   Fax:   (760) 433-0304
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