 Our Select Blend Dental PPO plan is administered through HealthComp. With this plan, you can visit any dentist of your choice. If you do not have a dentist, you will find additional savings by accessing a dentist contracted with Blue Cross.
To find a provider click here »
The Cost of the Select Blend PPO
is as Follows:
| Tier Of Coverage |
Your Per Pay Period Contribution |
Total Monthly Cost of Plan |
| Team Member (“TM”) Only |
$12.02 |
$27.08 |
| TM + Child(ren) |
$22.84 |
$52.00 |
| TM + Spouse/Domestic Partner |
$25.24 |
$56.33 |
| Family |
$36.06 |
$82.33 |
NOTE: If you require extensive dental treatment, please have your dentist submit a “Pre-Treatment Estimate” to HealthComp at P.O. Box 45018, Fresno CA 93718-5018. You may also fax the Pre-Treatment Estimate to 559-499-2464. A “Pre-Treatment Estimate” will provide you with your estimated out of pocket expenses for treatments required.
Select Blend Documents:
Summary Plan Description
Dental Claim Form Dental Claim Form
|
