| BlueCross & BlueShield of Oklahoma | ||
| Network: DNoA Preferred | ||
| Customer Service: 800 313 5162 | ||
| Website: www.bcbsok.com |
| $2,500 per individual, per plan year | ||
| Once reached, Member is responsible for 100% of dental claims for the remainder of the plan year |
| $25 per individual, per plan year |
| Free, twice per plan year | ||
| Not subject to Deductible | ||
| For Cleaning, Polishing, Bite-Wing X-Rays & Prophylaxis |
| 15% Co-Insurance after Deductible | ||
| For Fillings, Simple Extractions, Surgical Removal of Teeth & Root Canals |
| 40% Co-Insurance after Deductible | ||
| For Crowns, Full or Partial Dentures, Bridge Repairs & Occlusal Guards |
| 50% Co-Insurance | ||
| Not Subject to Deductible | ||
| For Dependent Children up to Age 26 Only | ||
| $1,500 Lifetime Maximum |
| Current & Former Employee Coverage & Rates for the 2024/25 Plan Year, effective 7/1/2024 through 6/30/2025. |
| 47.62 | Member | |||
| 25.16 | Child | |||
| 40.00 | Children | |||
| 58.82 | Spouse | |||
| 83.98 | Spouse & Child | |||
| 98.82 | Spouse & Children |
The only non-profit public trust health plan; owned, ran and for Oklahoma's local government organizations.