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This plan is available in 11 states
(CA,CO,CT,GA,IN,KY,MO,NH,NV,OH,WI)

Anthem Blue Cross Dental logo  Anthem Blue Cross Prime Dental & Vision Insurance 
(877)566-5454 Toll Free
SIDE-BY-SIDE OVERVIEW COMPARISON OF THE PLANS
PRIME PLAN A
PRIME PLAN B
PRIME PLAN C
In & out of network
In & out of network
In & out of network
Annual Deductible None $50 $50
Annual Maximum $500 $1,000 $1,250
DIAGNOSTIC & PREVENTIVE SERVICES - No waiting period for exams, cleanings & X-rays
Exams 100% 100% 100%
Cleanings 100% 100% 100%
X-rays 100% 100% 100%
Sealants 100% 100% 100%
Fluoride treatments 100% 100% 100%
BASIC SERVICES - 6 month waiting period for basic services
Amalgum fillings (silver) Not covered 80% 80%
Space maintainers Not covered 80% 80%
Basic tooth extractions Not covered 80% 80%
Brush biopsy Not covered 80% 80%
Emergency palliative treatment Not covered 80% 80%
COMPLEX AND MAJOR SERVICES - 12 month waiting period for major services
Endodontic therapy Not covered 50% 50%
Periodontal (gum) services Not covered 50% 50%
Complex Oral Surgery Not covered 50% 50%
Major restorative services
(replacing natural teeth)
Not covered Not covered 50%
Prosthetic services
(dentures, partials & bridges)
Not covered Not covered 50%
Prosthetic repairs Not covered Not covered 50%
Orthodontics Not covered Not covered Not covered
VISION CARE SERVICES
BENEFIT FREQUENCY
NETWORK SERVICES
NON-NETWORK REIMBURSEMENT
Eye Exam (with dilation as needed) Once every 12 months $20 copay Up to $30
Standard plastic (CR39) lenses Once every 24 months    
Single Vision   $20 copay Up to $25
Bifocal   $20 copay Up to $40
Trifocal (FT25-28)   $20 copay Up to $55
Contact lenses Once every 24 months    
Elective (conventional and disposable)   $80 allowance Up to $60
Non-elective   Covered in full Up to $210
Frames Once every 24 months $130 allowance Up to $45
DENTAL BENEFIT POLICY Prime Plan A Benefit Policy Prime Plan B Benefit Policy Prime Plan C Benefit Policy
OUTLINE OF COVERAGE Plan A Outline of Coverage Plan B Outline of Coverage Plan C Outline of Coverage
CALIFORNIA BROCHURE with PRICING California Prime Dental & Vision Plans Brochure with Pricing
APPLICATION Prime Dental & Vision Plans - PRINT & MAIL Application
APPLY ONLINE Prime Dental & Vision Plans - APPLY ONLINE

Dental rates and plans apply to members from age 18 to under age 65 and are subject to change.
Rate information for members 65+ is available upon request.
Annual rates reflect a 5% discount when pre-paying annually.


California Anthem Blue Cross Prime Dental Plans

Colorado Anthem Blue Cross Prime Dental Plans

Connecticut Anthem Blue Cross Blue Shield Prime Dental Plans

Georgia Anthem Blue Cross Prime Dental Plans

Indiana Anthem Blue Cross Prime Dental Plans

Kentucky Anthem Blue Cross Prime Dental Plans

Missouri Anthem Blue Cross Blue Shield Prime Dental Plans

Nevada Anthem Blue Cross Prime Dental Plans

New Hampshire Anthem Blue Cross Blue Shield Prime Dental Plans

Ohio Anthem Blue Cross Prime Dental Plans

Wisconson Anthem Blue Cross Blue Shield Prime Dental Plans




Anthem Blue Cross Dentist Database

Prime Dental CLAIM FORM

Anthem Blue Cross Vision Database


Or you can fill in this form to have your Anthem Blue Cross Dental Prime Plans Insurance brochure with pricing & application mailed to you. Further information on our plans is shown below. Or just call us Toll-free at 877-Look4Life (877-566-5454).
Anthem Blue Cross PPO Dental Insurance Coverage Requested
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(under age 65)
  My Age or DOB       Spouse's Age  
People Covered
Plan wanted

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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, 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 Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. 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: Blue Cross 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.

Important Disclaimer:  Answers and comments provided above are general information, and are not intended to substitute for informed professional medical, psychiatric, psychological, tax, legal, investment, accounting, governmental, or other professional advice. We do not endorse, and expressly disclaims liability for any product, manufacturer, distributor, service, health plan, or service provider mentioned or any opinion expressed in the website.  Replies, comments, or information gathered on BarricksInsurance.com  website may not be accurate but are intended to be helpful.

Barricks Insurance Services
13900 NW Passage #302, Marina Del Rey, CA 90292
Phone:   (310) 827-7286    |   Fax:   (310) 827-0256
Toll-Free 1-877-Look4Life  (1-877-566-5454)

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Licensed in AL, AR, AZ, CA, CO, CT, FL, GA, IA, IL, IN, KS, KY,
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