Blue Cross Blue Shield FEP Dental Brochure - 2022

 
 
 
Blue Cross Blue Shield FEP Dental
Rates
 
Rates
 
High – Bi-Weekly

Rating Area: 0
Self Only: $18.05
Self Plus One: $36.11
Self and Family: $54.16

Rating Area: 1
Self Only: $18.05
Self Plus One: $36.11
Self and Family: $54.16

Rating Area: 2
Self Only: $20.22
Self Plus One: $40.44
Self and Family: $60.66

Rating Area: 3
Self Only: $22.01
Self Plus One: $44.03
Self and Family: $66.04

Rating Area: 4
Self Only: $23.84
Self Plus One: $47.68
Self and Family: $71.52

Rating Area: 5
Self Only: $26.68
Self Plus One: $53.35
Self and Family: $80.03

High – Monthly

Rating Area: 0
Self Only: $39.11
Self Plus One: $78.24
Self and Family: $117.35

Rating Area: 1
Self Only: $39.11
Self Plus One: $78.24
Self and Family: $117.35

Rating Area: 2
Self Only: $43.81
Self Plus One: $87.62
Self and Family: $131.43

Rating Area: 3
Self Only: $47.69
Self Plus One: $95.40
Self and Family: $143.09

Rating Area: 4
Self Only: $51.65
Self Plus One: $103.31
Self and Family: $154.96

Rating Area: 5
Self Only: $57.81
Self Plus One: $115.59
Self and Family: $173.40

Standard – Bi-Weekly

Rating Area: 0
Self Only: $9.22
Self Plus One: $18.44
Self and Family: $27.67

Rating Area: 1
Self Only: $9.22
Self Plus One: $18.44
Self and Family: $27.67

Rating Area: 2
Self Only: $10.10
Self Plus One: $20.21
Self and Family: $30.31

Rating Area: 3
Self Only: $11.48
Self Plus One: $22.95
Self and Family: $34.40

Rating Area: 4
Self Only: $12.39
Self Plus One: $24.76
Self and Family: $37.12

Rating Area: 5
Self Only: $13.68
Self Plus One: $27.37
Self and Family: $41.05​​​​​​​

Standard - Monthly

Rating Area: 0
Self Only: $19.98
Self Plus One: $39.95
Self and Family: $59.95

Rating Area: 1
Self Only: $19.98
Self Plus One: $39.95
Self and Family: $59.95

Rating Area: 2
Self Only: $21.88
Self Plus One: $43.79
Self and Family: $65.67

Rating Area: 3
Self Only: $24.87
Self Plus One: $49.73
Self and Family: $74.53

Rating Area: 4
Self Only: $26.85
Self Plus One: $53.65
Self and Family: $80.43

Rating Area: 5
Self Only: $29.64
Self Plus One: $59.30
Self and Family: $88.94