Dental Pediatric

75293AR1230001
High
PPO

Dental Pediatric is a High PPO plan by Arkansas Blue Cross and Blue Shield.

Locations

Dental Pediatric is offered in the following counties.

No data was found

Plan Overview

This is a plan overview for 2025 version of Dental Pediatric 75293AR1230001.
Insurer: Arkansas Blue Cross and Blue Shield
Network Type: PPO
Metal Type: High
HSA Eligible?:
Plan ID: 75293AR1230001

Cost-Sharing Overview

Dental Pediatric offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for Dental Pediatric?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

Dental Pediatric offers the following features and referral requirements.

Wellness Program:
Disease Program:
Notice Pregnancy:
Referral Specialist:
Specialist Requiring Referral:
Plan Exclusions: See Policy for Details
Child Only Option?: Allows Child-Only

Network Details

The following network details will help you understand what Dental Pediatric covers when you are out of the service area or out of the country.

Out of Country Coverage: No
Out of Country Coverage Description:
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Benefit reduction for dental care by non-contracted providers
National Network: Yes

Additional Benefits and Cost-Sharing

Dental Pediatric includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Routine Dental Services (Adult)
Not Covered
Dental Check-Up for Children
Covered
Not Applicable No Charge after deductibleNot Applicable 25.00% Coinsurance after deductible2.0 Visit(s) per 6 Months
Basic Dental Care – Child
Covered
Not Applicable 20.00% Coinsurance after deductibleNot Applicable 40.00% Coinsurance after deductible Quantitative limit units apply
Orthodontia – Child
Not Covered
Major Dental Care – Child
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 70.00% Coinsurance after deductible Quantitative limit units apply
Basic Dental Care – Adult
Not Covered
Orthodontia – Adult
Not Covered
Major Dental Care – Adult
Not Covered
Accidental Dental

Free Preventive Services

There is no copayment or coinsurance for any of the following Dental Pediatric preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Ready to sign up for Dental Pediatric?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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