The Dental Plans cover preventive, basic, and major services, as well as orthodontia. Two options are available:
With the Anthem Blue Cross PPO Dental Plan you can visit any dentist and receive benefits; however, you will receive the greatest value for your dollar when you use network dentists. All dentists
nationwide participating in the Anthem Blue Cross Dental Blue Complete Network 100, 200 or 300 are considered Network dentists* under the LAPRA PPO Dental Plan. Network dentists have contracted with the plan to provide services at reduced rates, so using these dentists will save you money. Plus, deductibles do not apply when you use in-network dentists.
If you choose a non-network dentist, the plan will still provide benefits, but your out-of-pocket expenses may be higher, because the Anthem Blue Cross negotiated fees do not apply to non-network dentists. Other plan features include:
IMPORTANT: When using a non-network provider under the Anthem PPO Dental Plan, the maximum allowable charge is based on the customary and reasonable charge for professional services as determined by Anthem. Members are responsible for any difference between the non-network provider’s actual charge and the maximum allowable charge, as well as any deductible and/or coinsurance percentage.
* In Idaho, the provider network is under the Anthem PPO.
The HMO Dental Plan offers comprehensive coverage designed to fit your family’s budget. All services must be performed by an Anthem HMO Dental provider in order to be covered. Many services are covered at 100%, while others require a co-pay. Each family member may choose a different dentist. Deductibles and calendar year maximums do not apply. This plan is only available to California residents.
Click here for HMO Dental Plan Summary.
The table below provides an overview of the key benefits and bi-weekly contributions provided through the LAPRA Dental Plans. Refer to the Anthem PPO Dental Plan or HMO Dental Plan materials for a complete description of the LAPRA dental benefits including terms of coverage, exclusions and limitations.
Benefit Feature |
Anthem PPO Dental Plan |
Anthem HMO Dental Plan (California Residents Only) |
|
|---|---|---|---|
Providers |
Network Providers |
Non-Network Providers* |
HMO Dental Providers Only |
| Calendar Year Deductible | None |
$25 per person $50 per family (waived for Preventive & Diagnostic) |
None |
| Calendar Year Maximum | $2,000 per person (excluding Orthodontia) |
None |
|
| Preventive & Diagnostic • Cleanings • Exams • X-rays • Sealants |
100% (3/year) 100% 100% 100% |
100% (3/year) 100% 100% 100% |
No Charge No Charge No Charge $10 co-pay per tooth |
| Basic • Extractions • Fillings • Root Canal • Oral Surgery |
90% 90% 90% 90% |
80% 80% 80% 80% |
No Charge No Charge $0-$180 co-pay per tooth $0-$200 co-pay per tooth |
| Major • Crowns & Bridges • Dentures • Implants |
60% 60% 60% |
60% 60% 60% |
$100-$200 co-pay per tooth $150-$200 co-pay per tooth n/a |
| Orthodontia (including adults and children) |
50% |
50% |
$1,750 co-pay (child) $1,750 co-pay (adult) (Services exceeding a 24-month treatment period will require additional co-pays.) |
| Orthodontia Lifetime Maximum |
$1,750 per person (Includes $300 for
pre-orthodontic visit and treatment plan |
n/a |
|
* Benefits are based on the customary and reasonable charge. You are responsible for any difference between the amount charged and the customary and reasonable charge, plus any deductible and/or coinsurance amount.
Your cost for Dental is based on your select plan and coverage category as well as the amount of the City of Los Angeles subsidy. The table below reflects the member cost per pay period effective July 1, 2023.
Dental Plan Rates Captains and Above Effective July 1, 2023
Anthem Blue Cross PPO Dental Plan |
Anthem Blue Cross HMO Dental Plan (California Residents Only) |
|
|---|---|---|
| Single | $3.00 |
$0.00 |
| 2-Party | $18.50 |
$0.00 |
| Family | $21.00 |
$4.20 |
Dental Plan Rates Lieutenants and Below Effective July 1, 2023
Anthem Blue Cross PPO Dental Plan |
Anthem Blue Cross HMO Dental Plan (California Residents Only) |
|
|---|---|---|
| Single | $1.50 |
$0.00 |
| 2-Party | $17.00 |
$0.00 |
| Family | $19.50 |
$2.70 |
This brief description of benefits is provided for your convenience and is subject to all terms, conditions, limitations and exclusions of the Anthem Blue Cross and contracts. Please refer to your Evidence of Coverage for details on your benefits.