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The chart below provides highlights of your dental coverage for the Trooper Chapter, Airport Police and Fire Officers Chapter, Fairbanks Police Department, Fairbanks Fire Department and Juneau Police Department members, as of July 1, 2007. Refer to your Benefit Booklet for details, general limitations and exclusions.
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Diagnostic and Preventive |
Basic |
Major |
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Individual |
Family |
Individual |
Family |
Individual |
Family |
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Annual deductible* |
None |
None |
$25 |
$75 |
$25 |
$75 |
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Amount plan pays |
100% of eligible charge |
85% of eligible charge after you meet the deductible |
50% of eligible charge after you meet the deductible |
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Dental benefits maximum |
$1,500 per calendar year per person |
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Covered services |
- Up to two routine oral examinations per year
- Prophylaxis
- Topical application of fluoride – under age 20)
- Dental x rays (either complete series or panoramic once every 36 consecutive months)
- Space maintainers – under age 20
- Sealants for permanent teeth – under age 14
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- Simple extractions
- Oral surgery
- Fillings (one per 24 consecutive months, per tooth surface)
- Up to two periodontal treatments in any 12 consecutive months
- Endodontic treatment
- Repair of crowns, inlays, bridgework, and dentures
- Emergency palliative treatment
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- Covered restorations (Inlays, onlays, veneers, and crowns)
- Initial installation of partial/complete dentures
- Initial installation of fixed bridgework
- Replacement of partial/complete dentures and fixed bridgework
- Relining/ rebasing dentures
- Tooth build-ups, for covered inlays, onlays and crowns
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Pre-estimate of benefits |
Your dentist should submit a pre-estimate of benefits request for any proposed dental service or series of dental services for which the total charge will exceed $450 |
* A deductible is the amount you must pay for Basic and Major covered services each calendar year before benefits are payable.
Contact Information
Blue Cross Blue Shield of Alaska
P.O. Box 91059
Seattle, WA 98111-9159
Local and toll-free: 1-800-508-4722
Hearing-impaired TTY: 1-800-842-5357
Premera Blue Cross Blue Shield of Alaska: https://www.premera.com
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