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Dental, Vision and Hearing Benefits

For Capital Blue Cross Medicare HMO, Capital Blue Cross Medicare PPO, and WellSpan Health members

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Dental Benefits

Most of the time dental work isn’t covered by Original Medicare.

We help cover those gaps:

  • Annual routine cleanings
  • Palliative emergency treatment
  • Periapical x-rays
  • Amalgam and composite fillings
  • Simple (non-surgical) extractions
  • Endodontics
  • Major restorative (crowns and teeth fillings)
  • Prosthodontics
  • Prosthetics adjustments and repairs
  • Periodontal services (maintenance only)

You have two routine dental visits a year including:

  • Cleaning
  • Bitewing X-rays (Set of 2)
  • Oral Exam
  • Fluoride

Our Capital Blue Cross Medicare HMO and PPO benefits cut 50 percent of the cost for these services:

Non-routine dental services

  • Palliative Emergency Treatment
  • Periapical X-rays

Major Restorative Services:

  • Amalgam and composite fillings
  • Crowns
  • Inlays and onlays

Endodontics and Extraction Services:

  • Simple extractions (non-surgical)
  • Prosthodontics (including dentures) and adjustments
  • Repairs of prosthodontics

The plan has a maximum benefit coverage of up to $2500. This is used for comprehensive non-Medicare-covered dental services.

Important Information:

  • Authorizations and referrals are not required for routine dental services. Referrals are not required for comprehensive non-Medicare-covered dental services.
  • Coverage for simple extractions (non-surgical extractions) are typically performed by a general dentist. Surgical extractions are typically performed by an oral surgeon are not covered. (Members should confirm whether or not surgical extractions are covered under the Medicare medical plan.)
  • Excludes coverage for cosmetic procedures (such as veneers, bleaching, and teeth straightening), dental implants, periodontics, other oral/maxillofacial surgery and any other services not listed as covered.
  • PPO benefits reflect in-network coverage

Pre-Treatment Estimates:

If a member isn’t sure of the benefits for a specific course of treatment, or treatment costs are expected to exceed $300 our plan recommend a pre-treatment estimate. Members should ask the treating provider to submit the claim form in advance of performing the proposed services.

Pre-treatment estimate requests are not required but may be submitted for more complicated and expensive procedures, such as simple extractions, crowns and bridges. The member will receive an estimate of the costs and how much our plan may pay before treatment begins.

For information about your dental benefit, check your Evidence of Coverage or contact us at 800.779.6962 (TTY: 711), Monday through Friday, 8:00 AM - 8:00 PM.

Nominate your dentist

Need to file a claim?

Participating providers and some non-participating providers will submit claims for you. You can mail a dental claim form to:

Dental Claims Processing Center
P.O. Box 211424  
Eagan, MN 55121

Vision Benefits

Our plans offer affordable vision benefits that include:

  • Routine eye examination once a year.
  • Up to $150 annual plan allowance for eyeglass frames, eyeglass lenses, or contact lenses once every year.

As a Capital Blue Cross Medicare PPO member, you can pick any vision provider. If you choose a non-network doctor, you may pay more for your services.

Our Capital Blue Cross HMO members must choose a vision provider from our broad network.

Payment will be made for either eyeglass lenses and eyeglass frames or contact lenses within a benefit period.

For information about your vision benefits, refer to your Capital Blue Cross Medicare PPO evidence of coverage or call 866.987.4213 (TTY: 711) or your Capital Blue Cross Medicare HMO evidence of coverage or call 800.779.6962 (TTY: 711), Monday through Friday, 8:00 AM - 8:00 PM.

Need to file a claim?

Your providers may submit claims for you. You can submit a vision claim form to:

Capital Blue Cross Vision 
PO Box 2187 
Clifton, NJ 07015

Hearing Benefits

Worried About Hearing Loss?

You’re not alone. We got you covered. In fact, hearing loss is pretty common as we age. About one-third of people between the ages of 65 and 74 experience it. And about half of us 75 and over have difficulty hearing.

Hearing changes as we age and has a profound impact on our quality of life. It’s important to protect your hearing and even more important to know when it is time to seek help for hearing loss.

Our plan wants to ensure you have the hearing coverage you need. With our Capital Blue Cross plans, you’ll receive an annual Routine Hearing Exam at $0 cost to you and a $400 to $1000 allowance for Hearing Aids every year.

Program Features

  • $0 hearing aid fitting and evaluations.
  • Annual hearing test with no out-of-pocket cost.
  • Access to a nationwide network of 4,000+ trusted providers.
  • Brand-name hearing aids available from all major manufacturers.
  • Concierge services by dedicated Member Services.
  • Experience Advisors.
  • Three follow-up visits at $0 cost.
  • 3-year manufacturer’s repair warranty.
  • 3 years of batteries included.
  • One-time replacement coverage for lost, stolen or damaged hearing aids.
  • 12- and 18-month financing options available through contracted vendor.
  • Available with 0% APR, no money down.

In order to utilize our discounted hearing program, please contact a NationsHearing counselor today.

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Updated October 1, 2022


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