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Individual Plan Documents
- Sample Choice QF Policy
- Outline of Coverage BlueDental Choice QF
- Sample Choice QF Benefit Summary
- Sample Choice QF Benefit Summary (Spanish)
- BlueDental Choice PPO Application/Change
- Explanation of Benefits (EOB)
- How to Read Your EOB
- Out of Network Liability and Balance Billing
- Enrollee Claims Submission
- Claim Form
- Grace periods and claim pending policies
- Retroactive claim denials
- Enrollee recoupment of premium overpayments
- Medical necessity, prior authorization timeframes and enrollee responsibilities
- Coordination of benefits (COB)
- How to Avoid Retroactive Terminations
2021 BlueDental Choice Family (QF)
- Sample Choice Q Policy
- Outline of Coverage BlueDental Choice Q
- Sample Choice Q Benefit Summary
- Sample Choice Q Benefit Summary (Spanish)
- BlueDental Choice PPO Application/Change
- Explanation of Benefits (EOB)
- How to Read Your EOB
- Out of Network Liability and Balance Billing
- Enrollee Claims Submission
- Claim Form
- Grace periods and claim pending policies
- Retroactive claim denials
- Enrollee recoupment of premium overpayments
- Medical necessity, prior authorization timeframes and enrollee responsibilities
- Coordination of benefits (COB)
- How to Avoid Retroactive Terminations
2021 BlueDental Choice Pediatric (Q)
- Sample Copayment QF Policy
- Outline of Coverage BlueDental Copayment QF
- Sample Copayment QF Benefit Summary
- Sample Copayment QF Benefit Summary (Spanish)
- BlueDental Choice PPO Application/Change
- Explanation of Benefits (EOB)
- How to Read Your EOB
- Out of Network Liability and Balance Billing
- Enrollee Claims Submission
- Claim Form
- Grace periods and claim pending policies
- Retroactive claim denials
- Enrollee recoupment of premium overpayments
- Medical necessity, prior authorization timeframes and enrollee responsibilities
- Coordination of benefits (COB)
- How to Avoid Retroactive Terminations
2021 BlueDental Copayment Family (QF)
- Sample Copayment Q Policy
- Outline of Coverage BlueDental Copayment Q
- Sample Copayment Q Benefit Summary
- Sample Copayment Q Benefit Summary (Spanish)
- BlueDental Choice PPO Application/Change
- Explanation of Benefits (EOB)
- How to Read Your EOB
- Out of Network Liability and Balance Billing
- Enrollee Claims Submission
- Claim Form
- Grace periods and claim pending policies
- Retroactive claim denials
- Enrollee recoupment of premium overpayments
- Medical necessity, prior authorization timeframes and enrollee responsibilities
- Coordination of benefits (COB)
- How to Avoid Retroactive Terminations
2021 BlueDental Copayment Pediatric (Q)
- Sample Choice QF Policy
- Outline of Coverage BlueDental Choice QF
- Sample Choice QF Benefit Summary
- Sample Choice QF Benefit Summary (Spanish)
- BlueDental Choice PPO Application/Change
- Explanation of Benefits (EOB)
- How to Read Your EOB
- Out of Network Liability and Balance Billing
- Enrollee Claims Submission
- Claim Form
- Grace periods and claim pending policies
- Retroactive claim denials
- Enrollee recoupment of premium overpayments
- Medical necessity, prior authorization timeframes and enrollee responsibilities
- Coordination of benefits (COB)
- How to Avoid Retroactive Terminations
2020 BlueDental Choice Family (QF)
- Sample Choice Q Policy
- Outline of Coverage BlueDental Choice Q
- Sample Choice Q Benefit Summary
- Sample Choice Q Benefit Summary (Spanish)
- BlueDental Choice PPO Application/Change
- Explanation of Benefits (EOB)
- How to Read Your EOB
- Out of Network Liability and Balance Billing
- Enrollee Claims Submission
- Claim Form
- Grace periods and claim pending policies
- Retroactive claim denials
- Enrollee recoupment of premium overpayments
- Medical necessity, prior authorization timeframes and enrollee responsibilities
- Coordination of benefits (COB)
- How to Avoid Retroactive Terminations
2020 BlueDental Choice Pediatric (Q)
- Sample Copayment QF Policy
- Outline of Coverage BlueDental Copayment QF
- Sample Copayment QF Benefit Summary
- Sample Copayment QF Benefit Summary (Spanish)
- BlueDental Choice PPO Application/Change
- Explanation of Benefits (EOB)
- How to Read Your EOB
- Out of Network Liability and Balance Billing
- Enrollee Claims Submission
- Claim Form
- Grace periods and claim pending policies
- Retroactive claim denials
- Enrollee recoupment of premium overpayments
- Medical necessity, prior authorization timeframes and enrollee responsibilities
- Coordination of benefits (COB)
- How to Avoid Retroactive Terminations
2020 BlueDental Copayment Family (QF)
- Sample Copayment Q Policy
- Outline of Coverage BlueDental Copayment Q
- Sample Copayment Q Benefit Summary
- Sample Copayment Q Benefit Summary (Spanish)
- BlueDental Choice PPO Application/Change
- Explanation of Benefits (EOB)
- How to Read Your EOB
- Out of Network Liability and Balance Billing
- Enrollee Claims Submission
- Claim Form
- Grace periods and claim pending policies
- Retroactive claim denials
- Enrollee recoupment of premium overpayments
- Medical necessity, prior authorization timeframes and enrollee responsibilities
- Coordination of benefits (COB)
- How to Avoid Retroactive Terminations
2020 BlueDental Copayment Pediatric (Q)
- BlueDental Care Prepaid FI315 Application/Change (English)
- BlueDental Care Prepaid FI315 Application/Change (Spanish)
- BlueDental Care Prepaid FI315 Benefit Schedule
- BlueDental Care Prepaid FI315 Benefit Summary (English)
- BlueDental Care Prepaid FI315 Benefit Summary (Spanish)
- Claim Form
