Highlights of Your Braven Dental Benefits

Your Dental Benefits

As a Braven Health member, you’ll find your dental benefits have a lot going for them. You won’t have to pay much in out-of-pocket costs for covered in-network routine (preventive) services. And you have a $0 yearly deductible and an annual out-of-pocket maximum of $1,000 for comprehensive services.

To check that your dentist is in the network, visit BravenHealth.com/find-doctor.

Here’s how your coverage breaks down:

For routine dental services (that are preventive/diagnostic), in- and out-of-network, you’d pay:

• $0 copayment for a cleaning (up to three per year)
• $0 copayment for a fluoride treatment (once every six months)
• $0 copayment for a full-mouth X-ray (once every three years)
• $0 copayment for a bitewing X-ray (once every six months)
• $0 copayment for an oral exam (up to three per year)

But when you see an out-of-network provider, Braven Health will only pay up to the allowed amount for each covered service. So additional provider charges may apply.

For comprehensive dental services (restorative, endodontics, periodontics and simple extractions), meaning:

• Fillings (composite and amalgam): replacement once per six months per tooth
• Simple extractions (teeth removal)
• Periodontal (gum) maintenance
• Periodontal root planing (deep cleaning below the gum line): Up to one time per calendar year
• Root canal therapy: As necessary according to our administrative guidelines
• General anesthesia: Whenever necessary with extractions or other covered dental services

You pay the following, in- and out-of-network:

• 50% of the cost of the service(s)
• We cover up to $1,000 per year toward comprehensive dental services (coverage maximum doesn’t apply to preventive and diagnostic services)

Again, if you see an out-of-network provider, Braven Health will pay 50% of the allowed amount up to the $1,000 annual maximum. Additional provider charges will apply.

You might be asking, what’s not covered? Non-covered services include but aren’t limited to:

• Crowns/inlays/onlays
• Dentures
• Implants
• Prosthodontics
• Oral/maxillofacial surgery (including surgical extractions)
• Orthodontics
• Sealants
• Space maintainers
• Missing teeth
• Services related to temporomandibular joint dysfunction (TMJ)

More About Out-of-Network Care

Keep in mind: Out-of-network dentists are not obligated to accept Braven Health payment rates (also called an “allowed amount”) as payment in full. If you see an out-of-network dentist, you’ll pay the difference between the amount the out-of-network dentist charges and Braven Health’s allowed amount.

Routine Dental Care Out-of-Network

The out-of-network dentist may bill you the difference between the amount Braven Health pays and the amount the dentist normally charges for their services. For example, if the out-of-network dentist normally charges $200 for a cleaning and Braven pays the dentist the allowed amount of $100, your dentist may bill you an additional $100 to cover the difference.

Comprehensive Dental Care Out-of-Network

Braven Health will pay 50% of the amount we would normally pay an in-network dentist for a specific service. You will pay the other 50%, plus any difference between Braven’s allowed amount and the amount your dentist normally charges for a specific service.

For example, if the out-of-network dentist charges $500 for an extraction and Braven’s allowed amount is $200, you’ll pay $100 toward your coinsurance (50%). But your dentist may bill you for an additional $300 to cover the difference.

Visit BravenHealth.com/find-doctor to find a participating dentist near you.

Questions?

If you have any questions about your dental coverage or need help finding a participating dentist, call Member Services for your dental benefits at 1-855-648-1405 (TTY 711).