Anthem Dental Complete
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Some say dental plans with carryover provisions can be confusing
We say, once you get it, it’s pretty simple. Here’s an overview so you can feel comfortable including them in your benefits.
It’s like rollover minutes – almost
We offer dental plans that reward members when they visit the dentist and submit claims within a certain amount. Members can get a $250 reward yearly, when they follow certain rules. This money carries over each year when it’s not used. This is called a “maximum carryover provision.”
- Members in the plan need to submit at least one claim during the benefit year. (See “The rules” for more details on the types of services that qualify.)
- At the end of the benefit year, all of the member’s claims paid by the plan are totaled. If they do not go over $500, then the member qualifies for the $250 reward.
- The member gets $250 to use the next benefit year.
- If this money does not get used, it carries over year after year.
- The member will receive the $250 each qualifying year until the account hits $1,000.
There are a few rules to follow in order to qualify for the carryover:
Members must be enrolled in the dental plan for one full benefit year before the carryover kicks in.
The claims submitted must be for covered services that are subject to an annual maximum including annual exams and cleanings.
Benefits subject to a lifetime maximum (such as orthodontic services) do not qualify.
If coverage is lost at any time during the calendar year, the carryover account balance resets to zero.
It works year after year.
In order for your employees to get the most out of these plans, they need the ability to carry over their funds each year. When you renew, your employees benefit.
Let's look at an example*
The easiest way to understand the maximum carryover provision is to think about the money sitting in its own account separate from any funds available to the member through the plan benefits. The annual plan benefit amounts vary from plan to plan; for our example, we will use an annual plan amount of $1,000.
The terms below will help you understand the maximum carryover provision. The amounts below are benefit year maximums.
Plan annual maximum
The amount the plan provides for covered services.
Claim threshold amount
The total amount of claims a member can file in one benefit year to get the carryover reward.
The amount given to the member when claims are $500 or less for the year.
Carryover account maximum
The total amount a member can build up from carryover rewards.
Gina starts the year with $0 in her carryover account. During the year, she submits $325 in claims. This amount does not go over the claim threshold of $500, so Gina gets the $250 carryover reward deposited into her carryover account in case she needs it for future dental services.
Gina’s carryover account has $250. She submits $600 in claims. This amount goes over the threshold so she does not get the carryover reward, but her claims are less than her $1,000 plan annual maximum so she gets to roll over all of the $250 in her carryover account to the next year.
Gina's carryover account still has $250. She submits $1,050 in claims. This uses up all of her plan annual maximum and $50 is taken from her carryover account.
Gina's carryover account has $200 left in it. She submits $100 in claims. This amount does not go over the claim threshold of $500, so Gina gets $250 deposited into her carryover account again.
Gina's carryover account has $450. Gina can continue to get $250 rewards each year until her carryover account hits $1000.
*This is an example for illustrative purposes only. Actual rates, benefits, and experiences will vary.
Your role in all of this
You have two important steps to take to make sure your employees can get the most of their carryover provisions:
- Get the word out to your employees that you offer this type of dental plan in your benefits.
- Renew the plan year to year so carryover funds can be used by your employees if needed for future dental procedures
To learn more about carryover dental plans, contact your account representative.
Better understand the costs for your dental care.
You can make better decisions about your dental care when you have a better understanding of your treatment options and costs. That’s why Anthem’s Dental Care Cost Estimator is such a valuable tool.
Understand your costs ahead of time
This user-friendly, web-based tool provides estimates for common dental procedures and treatments, giving Anthem members even more opportunities to understand their dental care costs prior to receiving their care.
How it works
It takes only 3 steps to get cost estimates for specific dental treatments.
- Log in to the Anthem Dental Member Services portal at the website noted on your ID card for our Dental Prime, Dental Complete and Smart Access plans.
- Select “Dental Care Cost Estimator” from the menu.
- Begin your search.
A. Enter your dentists' ZIP code
B. Enter either a keyword (e.g. cleaning), a dental procedure code or select a dental procedure category
Your search results will display 2 cost estimates.
1. "Free Range" - This is a range of fees that dentists in the ZIP code provided charge for that procedure.
2. "In-Network Fee" - The specific cost for the procedure charged by participating Dental Prime, Dental Complete and Smart Access network dentists in that Zip Code.
Get the final details from your dentist
Your Anthem dental benefits may pay a portion of treatment cost, and you may also be required to pay a portion of the cost yourself. As always, talk with your dentist and have them provide detailed costs for your treatment including how much is covered by insurance and how much you will need to pay.
Log in to Anthem Dental Member Services portal at the website noted on your ID card to use the Dental Care Cost Estimator.
Life and Disability products underwritten by Anthem Life Insurance Company, an independent licensee of the Blue Cross and Blue Shield Association. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado and Nevada: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem HealthPlans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: BlueCross Blue Shield of Wisconsin (“BCBSWi”), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (“Compcare”), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
This webpage is not intended to be a contract. It is a summary of a benefit or service that is dependent on the plan option chosen. These policies have exclusions, limitations and terms under which they may be continued in force or discontinued. For costs and complete details of the coverage, contact your insurance agent or Anthem or visit us at anthem.com.
As of January 2013 the Colorado Dental Prime* and Complete networks have no contracted dentists in the following counties: Baca*, Chaffee*, Cheyenne*, Crowley, Dolores, Eagle*, Elbert*, Gilpin, Grand, Hinsdale, Jackson, Kiowa, Lake*, Mineral, Moffat*, Ouray, Phillips, Pitkin, Rio Blanco, Saguache, San Juan, San Miguel*, Sedgwick, Washington*, and Yuma*.