Blue Cross Blue Shield FEP Dental Brochure - 2022

Blue Cross Blue Shield FEP Dental
Section 3 How You Obtain Care
Example 1: High Option coverage (In-Network provider). This example assumes all deductibles have been met and annual maximums have not been reached.
BCBS FEP Dental member with FEHB coverage – FEHB is always primary
Services are provided by an In-Network Provider
1-surface filling: $108.00
Maximum Allowable Amount: $60.00
FEHB payment (estimated): $16.00
BCBS FEP Dental benefits payable in the absence of FEHB coverage: $42.00 ($60.00 at 70%)
Payment by BCBS FEP Dental: $42.00
Member’s responsibility: $2.00 ($60-$16-$42=$2.00)