Small Business Dental plans
2025 Dental updates:
Prepare for 2025 Dental PPO plan withdrawals
As part of our product transformation and portfolio simplification efforts, three DPPO plans will be withdrawn from our Specialty portfolio beginning January 1, 2025. See mapping grid for list of withdrawn plans and corresponding recommended available plans. You can also use the Plan Comparison Tool to compare benefits between a withdrawn plan and new available plan by using the compare year over year function. Plans being withdrawn:
- Smile℠ Deluxe 50/1500/Ortho/MAC
- Smile℠ Deluxe Gold 50/1500/Ortho/U85/NR
- Ultimate Dental Plus PPO for Small Business 50/2000/Ortho/MAC/NR
To view and compare all available dental plans use the Plan Comparison Tool.
Rates for closed plans can be found by looking up the plan ID number in our rate manual under “Closed Rate Book – includes closed Specialty (all regions: 1-19).”
Minor language and benefit updates to the DPPO Evidence of Coverage
Added clarifying language to Orthodontic Services where the copayment or coinsurance for Orthodontic Services applies to one course of treatment per lifetime. The course of treatment must be received in a 24 consecutive month period as long as the employee remains enrolled in the plan. If your group has any questions or a need for a complete list of limitations and exclusions for specific dental procedures, please contact Dental Customer Service at (888) 271-4880, these instructions were added to the EOC. Updated the sedation/ anesthesia benefits to a 30-minute maximum limit for deep sedation/ general anesthesia that applies to all DHMO, Dental In-Network Only, and DPPO plans.
Why add a Blue Shield dental plan?
Bundled savings – now provide a 10% specialty premium discount
Give your small business clients a 10% specialty discount! Anytime you add dental and/or vision to a new or existing small business client's medical coverage, a 10% discount will be applied to the dental and/or vision premiums.
Streamlined administration
This means one bill, one renewal, and one point of administration for all of your clients' Blue Shield business. And, your clients can access and manage all of their coverage information through Employer Connection.
Two-year initial rate guarantee
A two-year initial rate guarantee applies to both new and existing medical groups adding a dental or vision plan, and/or life insurance.
Access to Blue Shield’s dental networks
Members have access to one of the largest dental PPO or dental HMO networks with their dental plans from Blue Shield in California and nationwide. This gives dental PPO members the flexibility to choose from a large number of providers in and out of network, while dental HMO members can maximize their plan's value by accessing dental care at qualified in-network providers.
Plan choice
Blue Shield offers a variety of dental PPO and HMO plans with no waiting periods. Groups can also offer voluntary options to their employees. Our flexible dual and triple options let you offer two or three dental plans.
- Any two dental plan options may be selected under the dual option provision.
The following combination of three dental plans may be selected:
- Any two DHMO plans with any DPPO plan
- Any three DHMO plans
The following additional combination of three dental plans may be selected only when purchased with Blue Shield of California small business medical coverage:
- Two DPPO plans that have an orthodontic benefit or two DPPO plans that do not have an orthodontic benefit with any one DHMO plan
Orthodontia coverage
All DHMO plans include orthodontic coverage for all ages. Our new dental PPO portfolio includes plans with child-only, child and adult, or no orthodontic coverage to help employers find the right plan for their employees. DPPO plans with orthodontic coverage are also offered for all ages with either a $1,000 calendar-year maximum over 24 months or as a lifetime benefit up to the ortho max amount on the plan.
Coverage for Invisalign “invisible” (clear) braces is included in our plans. Members are responsible for any costs over the amount of traditional braces. Learn more about orthodontia coverage.
Oral cancer screening benefit
All dental PPO plans include an oral cancer screening benefit covered at 100%. Oral cancer can hide below the surface, and detecting it early can greatly improve treatment success.
Caries risk management
An additional benefit for children who are at risk for tooth decay.
Dental coverage is available with or without Blue Shield medical coverage.
Pediatric dental benefits are included and embedded with medical plans.
Pediatric dental benefits are included in our small business medical plans. PPO, HSA, and HMO medical plans provide the same PPO dental coverage for pediatric dental benefits, but only PPO and HSA medical plans will offer coverage for pediatric dental benefits received from non-network providers, at non-network provider benefit levels. There is no coverage for non-network pediatric dental benefits in our HMO medical plans, except for emergencies. Dental and vision care are required essential health benefits (EHBs) under the Patient Protection and Affordable Care Act of 2010 (ACA) for children up to age 19.
Pediatric Dental and Vision FAQs
Contribution requirements
A 50% contribution is required for all dental plans∞ except Voluntary Dental plans; no employer contribution is required.
Dental plan acronyms explained for closed plans:
| Specialty acronyms | Definition | Additional clarification | Applicable advantages |
|---|---|---|---|
| ADV | Advantage |
Member use of In-network providers can help reduce out-of-pocket costs for the member by reimbursing providers at a higher rate for the delivered services. | |
| UCR | Usual, customary, reasonable |
Meaning Blue Shield of California will only pay what we consider to be a usual, customary, and reasonable charge for any covered expenses incurred. | UCR plans can help members get maximum out-of-network providers and are good for groups with employees in remote areas. |
| MAC | Maximum allowable charge |
This is a feature that will help our members save on out-of-pocket costs. Claims are paid according to the PPO fee schedule (maximum allowable charge). If a non-PPO provider is used, the member will pay a higher fee. | MAC plans can reduce premiums and are also advantageous when the majority of a group's providers are participating in the insurer's network. Groups that have not had dental coverage before can benefit from a MAC plan because premiums are typically lower. |
| NWP | No waiting period |
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| WP | Waiting period |
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| INO | In-network only |
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| NR | No rollover |
∞ Voluntary dental plans have a 12-month waiting period for major services. For groups selecting voluntary PPO dental that have prior dental coverage including “major” benefits for 12 months or more, the 12-month waiting period will be waived for all initial enrollees.
