All Dental benefits utilize a PPO provider network regardless of the type of medical plan you have selected. Deductibles and benefit payments are based on allowable charges. Review the Dental Plan Contract posted below for details on waiting periods, exclusions and benefit amounts. Your Group Number for the Blue Cross dental plan is 10040000
NOTE: Orthodontic services are for eligible dependent children up to age 19 if the treatment has begun by age 17.
Deductibles and Benefit Limits are per benefit period, except the Orthodontic Benefit Limit which is a lifetime limit.
Important Links
The links below provide information further detailing the State’s current dental plan.
FY25/FY26 Dental Benefit Summary
FY26 Dental Policy
FY25 Dental Policy
Finding a Dental Provider
Contact Blue Cross at 800-358-5527
Dental Plan Comparison
Plan Year Benefit: $1,500 maximum per member benefit
• Deductible: $50 per member (except listed preventive services)
• Pediatric Orthodontia Benefit: $1,000 lifetime maximum
| Type | Covered Service (see contract for full list) | In-Network Contracting Providers – PPO | Out-of-Network Providers |
|---|---|---|---|
| Preventative & Diagnostic | Oral exam & cleanings | 100%, no deductible | 70% after deductible |
| Basic | Fillings, extractions, root canals, etc. | 80% after deductible | 50% after deductible |
| Major | Crowns, bridges, dentures | 50% after deductible | 50% after deductible |
| Orthodontic (Pediatric) | Pediatric benefit only | 50% after deductible | 50% after deductible |
| Other | 80% after deductible | 70% after deductible |