Blue Cross Blue Shield of Colorado Dental Rate Grid
Anthem Blue Cross of Colorado Dental PPO Plan for Individuals and Families Rates Effective July 1, 2006 and still valid through 2013.
| Coverage | Monthly Premium |
|---|---|
| One Adult | $36.91 |
| Two Adults | $73.82 |
| Adult with one child | $58.94 |
| Adult with two children | 80.97 |
| Adult with three or more children | $103.00 |
| Family (one child) | $95.85 |
| Family (two children) | $117.88 |
| Family (three or more children) | $139.91 |
| One child | $22.03 |
| Two children | $44.06 |
| Three or more children | $66.09 |
*These rates may not be current.
Calendar-year Deductible
You’re responsible for a $50 per person deductible per calendar year, with a maximum of three deductibles per family ($150), before you receive benefits for covered services. The calendar-year deductible is waived for preventive and diagnostic services when they’re provided by an in-network dentist.
Calendar-year Maximum Benefit
Your Anthem Blue Cross and Blue Shield dental benefits are limited to $1,000 for each enrolled member during a calendar year.
Waiting Periods
Coverage for preventive and diagnostic care begins on your plan effective date. Coverage for basic care begins after six continuous months of coverage, and coverage for major care begins after 12 continuous months of coverage.
Application and More Details
The information shown above is just the most requested information, please see the Anthem Blue Cross Dental Brochure for more information about the plan and for the application. Please add any more information/make changes to this page you think may be needed.
