Pediatric dental and vision
The health of your child’s teeth also has a major impact on digestion, growth rate and many other aspects of overall health. That’s why all CareFirst medical plans provide kids under age 19 with dental benefits at no extra charge.
Pediatric Dental
To access the preferred dental provider directory, visit Find A Doctor and select "Preferred Dental (PPO & Pediatrics)."
IN-NETWORK |
OUT-OF-NETWORK |
|
|---|---|---|
| Individual Cost Per Day | Included in your medical plan premium—no additional monthly charge | |
| Deductible | $25 Individual per calendar year (Applies to Classes II, III & IV) | $50 Individual per calendar year (Applies to Classes II, III & IV) |
| Network | Over 4,500 providers in D.C., MD and Northern VA. 135,000 dentists nationally. | |
| Preventive and Diagnostic Services (Class I) Oral exams, X-rays, fluoride treatments, sealants, palliative treatment |
No charge | 20% of allowed benefit* (no deductible) |
| Basic Services (Class II) Fillings, simple extractions, non-surgical periodontics Major Services—Surgical (Class III) Surgical periodontics, endodontics, oral surgery |
20% of allowed benefit* after deductible | 40% of allowed benefit* after deductible |
| Major Services—Restorative (Class IV) Inlays, onlays, dentures, crowns |
50% of allowed benefit* after deductible | 65% of allowed benefit* after deductible |
| Orthodontic Services (Class V) When medically necessary |
50% of allowed benefit* (no deductible) | 65% of allowed benefit* (no deductible) |
Pediatric Vision
Vision benefits are offered to your family members up to age 19 through our network administrator, Davis Vision.** These important benefits include:
- One no-charge in-network eye exam per calendar year, or up to $40 reimbursement for an out-of-network exam per calendar year
- No copay in Davis Vision collection (in-network) for frames and basic spectacle lenses or contact lenses
- Reimbursement for single vision lenses, up to $40, and frames up to $70, from an out-of-network provider
For a routine eye exam, just call and make an appointment with one of the many Davis Vision providers. Remember, the pediatric vision benefits listed above are available to your family members up to age 19 for no additional charge to your monthly premium.
To locate a vision care provider, contact Davis Vision at 800-783-5602 or search our network for a Davis Vision provider.
Not all services and procedures are covered by your benefits contract. This plan summary is for comparison purposes only and does not create rights not given through the benefit plan.
CareFirst payments are based upon the CareFirst allowed benefit. Participating dentists accept 100% of the CareFirst allowed benefits as payment in full for covered services. Non-participating dentists may bill the member for any amount over the allowed benefit. Providers are not required to accept CareFirst’s allowed benefits on non-covered services. This means you may have to pay your dentist’s entire billed amount for these non-covered services. At your dentist’s discretion, they may choose to accept the CareFirst allowed benefit, but are not required to do so. Please talk with your dentist about your cost for any dental services.
* CareFirst partners with Davis Vision to offer an extensive national network of optometrists, ophthalmologists and opticians. Davis Vision is an independent company that provides administrative services for vision care to CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (CareFirst) members. Davis Vision is solely responsible for the services it provides.
** Please note: In accordance with the provisions of the Affordable Care Act (ACA), every CareFirst plan includes basic dental coverage and vision benefits for children up to age 19.