Dental and Vision Benefits on BlueChoice Individual Health Insurance Plans

BlueChoice HealthPlan sells Obamacare-compliant individual health insurance plans throughout South Carolina. These plans are marketed as “Blue Option” plans and provide better value for the money than the plans available on the Marketplace.

A big part of that additional value is the fact that these plans include a vision and preventive dental reimbursement as a standard part of their coverage.

Enhanced Vision Coverage on BlueChoice Blue Option Plans

All Blue Option plans include routine adult and pediatric vision coverage through an independent company, Physicians Eyecare Network (PEN). PEN is an independent company that provides vision services through the Physicians Eyecare Plan (PEP) network on behalf of BlueChoice HealthPlan.

Pediatric Vision Benefits (ages up to 19)

  • $15 copay for one routine eye exam*
  • One standard contact lens fitting with a $49 copay* or 15% discount off the provider’s non-standard contact lens fitting fee.
  • $150 material allowance with a $25 copay* every benefit period that can be spent on frames, lenses, lens upgrades, and contacts. Members are not limited by a frame, lens or contact lens selection. Benefit can be used for prescription sunglasses.
  • Discounts of 20% on glasses and 15% on contacts on any amounts spent over the material allowance (at most providers). Necessary contact lenses are covered in full for specific conditions for which contact lenses provide better visual correction. For out-of-network providers, the member is reimbursed up to $40 for a routine eye exam and up to 65% of the material allowance that is used, less material copay.

Adult Vision Benefits (ages 19 and over)

  • $0 copay for one routine eye exam
  • One standard contact lens fitting with a $49 copay or a 15% discount off the provider’s non-standard contact lens fitting fee.
  • $150 material allowance with a $0 copay every benefit period that can be spent on frames, lenses, lens upgrades, and contacts. Members are not limited by a frame, lens or contact lens selection. Benefit can be used for prescription sunglasses.
  • Discounts of 20% on glasses and 15% on contacts on any amounts spent over the material allowance (at most providers). For out-of-network providers, the member is reimbursed up to $40 for a routine eye exam and up to 65% of the material allowance that is used, less material copay.

Members can click here to locate a network vision care provider.

Preventive Dental Care

Blue Option coverage also includes reimbursements for preventive dental care like exams and cleanings. These include:

  • One exam every six months: $50 allowance
  • One cleaning every six months: $50 allowance

Members will be responsible for paying any additional balance above that reimbursement amount. You will need to submit a dental reimbursement form to BlueChoice HealthPlan for reimbursement. (We can send this form to you if you need it).

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