Dental Insurance - Blue Cross Blue Shield

Blue Cross Blue Shield                           BCBS Dental Blue Certificate

601 S. Gaines St.                                 Elective Dental Coverage
Little Rock, AR 72201                                                          


Claims Inquiries & Pre-Determinations: 1-800-746-5684
Benefits & Eligibility: 1-800-238-8379
www.arkansasbluecross.com

Submit claims and pre-determination requests to:
ABCBS Dental Claims Unit
PO Box 69413
Harrisburg, PA 17106-9413

Group Numbers: Base Plan - 017492, Enhanced Plan -017493

* both spouses are full-time employees at UCA

Answers to Frequently Asked Questions:

1. Where can I check on the status of a claim?
   
   You may call customer service at 1-800-746-5684.
   
   
2. Can I use any dentist?
   
   1. If the dentist is participating with Arkansas Blue Cross Blue Shield the dentist has agreed to file your claim for covered services.  They agree to accept allowable fees and not charge you more than that amount.  You are still responsible for your deductible, coinsurance and ineligible services.  Payments for services by your dental plan are made directly to the participating dentist.
      
   2. If the dentist is not participating with Arkansas Blue Cross Blue Shield, you may be required to file your claim form.  All non-participating dentist claims payments will be made directly to you.  Since non-participating dentists are not obligated to accept Arkansas Blue Cross Blue Shield's negotiated allowable fees, you may owe the difference between the amount billed and Arkansas Blue Cross Blue Shield's allowed amount.  You will need to make payment directly to the dentist.
   
   
3. How can I determine if a dentist is in the network?
   
   1. call customer service at 1-800-746-5684
   2. visit website at www.arkansasbluecross.com
   3. use provider directory
   4. ask the dentist
   
   
4. How can I get a new ID card?
   
   You may call customer service at 1-800-746-5684 or contact the UCA Human Resources office at 501-450-3181.
   
   
5. What is a deductible?
   
   This is the fixed dollar amount that must be paid by the covered person before Arkansas Blue Cross Blue Shield will assume liability.
   
   
6. How much is the deductible?
   
   The calendar year deductible is $50 per calendar year per covered member.
   
   
7. What is a Pre-Determination?
   
   A simple courtesy that your dentist should provide.  It allows you to know in advance how much services will cost and if they are covered by your plan.  A Pre-Determination is always submitted in writing by your dentist to the dental claim administrator.  A phone call or web site review to check benefits or coverage is not a Pre-Determination.
   
   
8. Is a Pre-Determination required prior to services being rendered?
   
   Arkansas Blue Cross Blue Shield requires a Treatment Plan for services for which the dentist expects to bill $300.00 or more.  When a Treatment Plan is required, the dentist must submit the Treatment Plan for Pre-Determination prior to performing any covered service.  Substantiating material such as radiographs must be submitted with the Treatment Plan when requested by Arkansas Blue Cross Blue Shield.  If a treatment plan or substantiating material such as x-rays and narratives requested are not submitted, Arkansas Blue Cross Blue Shield reserves the right to determine benefits payable; taking into account alternate procedures, services, or courses of treatment, based on accepted standards of dental practice.
   
   
9. As a new employee, when is my dental insurance coverage effective?
   
   Your dental coverage under the "base" plan starts the first of the month following 3 months of full-time employment.
   
   
10. As a new employee, when am I eligible for the "enhanced" plan?
    
    One year after the "base" plan was effective.  For example:  Your "base" plan coverage was effective June 1, 2005.  You're eligible for the "enhanced" plan coverage effective June 1, 2006.
    
    Note:  Written request is required from employee before transferring employee's coverage from "base" to "enhanced".
    
    
11. When can I add/delete a family member to/from my policy?
    
    If the family member is not added to the policy when the employee begins working, the family member may only be added:
    
    1. within 30 days of a qualifying event and/or
    2. during "open enrollment".
       
    A family member may be deleted from the policy:
    
    1. within 30 days of a qualifying event,
    2. during "open enrollment", or
    3. at any time if the premiums from paycheck are "after-tax".
    
    
12. What is a "qualifying event"?
    
    Family changes such as:  Marriage, divorce, birth/adoption of a child, death, etc.
    Or Job Status changes such as:  spouse has new job with benefits, spouse leaves current job with benefits, spouse's employer is having "open enrollment" with significant benefit rate changes, etc.
    
    Please call Human Resources if you are unsure if your situation qualifies.
    
    
13. When does my child become ineligible for coverage?
    
    Your child is covered until he/she turns age 19.  From age 19 to age 23, the child must be a full-time student at an accredited college or university.  Proof of student status is required at least once per academic year.  Proof could be required more often in certain circumstances.
    
    This information along with the request letter from Blue Cross & Blue Shield  should be mailed to Blue Cross & Blue Shield.