Anthem Blue Cross Blue Shield of Kentucky
Dental Blue... It's All About Simplicity

Comprehensive dental benefits for you and your family. Regular dental checkups and cleanings are important to your overall health. They also help you feel better about yourself. That;s why they're 100% covered within your plan network by Dental Blue.

No matter which plan you choose, the network will include some of the best dental care around. Dental Blue has thousands of dentists, and every one is a credentialed provider. Also, every contracted specialits (such as oral surgeons and periodontists) can be found in all three Dental Blue network tiers.

The Dental Blue Plans - With Dental Blue, you have three choices of plan designs. Blue Basic 100, Blue Essential 100 and Blue Essential 200.

1. Dental Blue Basic 100: Provides coverage for the basics, including routine dental check-ups and fillings. If your dental needs are simple, this may be the right plan for you.

2. Dental Blue Essential 100: Includes coverage for the basics, plus services like crowns, bridges, root canals and dentures. If you think you may need a plan that offers more comprehensive benefits, this is the right plan for you.

3. Dental Blue Essential 200: Has basically the same coverage as Dental Blue Essential 100 but gives you wider choice of network dentists in exchange for a slightly higher cost. If your favorite dentist is in Anthem's larger network, this plan may be the best choice for you.

Dental Blue 100 &
Dental Blue 200

** All deductibles are per member per calendar year

Preventive and diagnostic care: Services that help your dentist make sure your teeth and gums are healthy. Routine checkups, cleanings, x-rays, oral evaluations, flouride applications.

Basic Plan: filings and space maintainers are included in Minor Restorative dental care; extractions are not covered.

Essential Plans: fillings and extractions are included in Minor Restorative dental care; space maintainers are included in Preventive and Diagnostic dental care.

Major restorative dental care: Crowns, bridges, root canals and dentures

Anthem Blue Cross Blue Shield of Kentucky
Dental Blue Application

To apply for coverage simply download, print, complete and FAX the application to FAX# (415) 651-8696:

HOW TO APPLY:

1. Select Dental Blue Plan from the brochure available above
2. Download & Print the application file to the right
3. Be sure to select credit and complete the card payment section of the application
4. FAX completed applications to (415) 651-8696
5. Or Apply online by clicking the orange "Apply Online Now" button below.

MAILING ADDRESS

Application Processing
P O Box 6374
Jackson Hole, WY 83002

FAX # (415) 651-8696

If you want a specific effective date please indicate this on your dental application.