Here's how the plan works…
With Anthem's Individual Dental plan, there's no health underwriting — that means no medical questions to answer. To get the highest level of benefits, choose from our network of participating dentists. Of course, you're also free to choose a dental provider outside the network, but your share of the cost may be greater. When you visit a network dentist, you have no deductible or coinsurance to pay for any covered preventive or diagnostic service. You can also benefit from the convenience of our automatic claims filing when you visit a network dentist. In most cases, your claims are filed for you, saving you the time and hassle.¹ Best of all, Anthem's Individual Dental Plan is available exclusively from Virginia's largest health insurer², Anthem Blue Cross and Blue Shield. Now that's something to smile about!  
Anthem Individual Dental has an annual maximum benefit of $1,000 per covered person every calendar year the policy is in effect. This applies to preventive, restorative, and complex benefits.  
Preventive Benefits
Preventive, diagnostic and radiographic benefits do not require a deductible or a waiting period. And when you visit a network dentist, we cover these benefits at 100% of our allowable charge - your coinsurance is 0%. We cover 50% of the allowable charge when you visit a dentist outside the network. 

Covered Service Frequency Coinsurance
(Oral exams) 
Two per year
Set of bitewing X-rays
(not in same year as full mouth x-ray) 
One per year
(not in same year as full mouth x-ray)
Full mouth X-rays
(Age 5 and over) 
One every three years 
(includes cleanings, topical fluoride treatments for children under age 16, space maintainers for children under age 12) 
Two dental cleanings per year

Restorative and Complex Benefits
Restorative and complex services have waiting periods before services are covered. You pay a $50 annual deductible with an in-network dentist, and a separate $100 annual deductible when you go out-of-network.  

Covered Service Waiting Period Coinsurance Deductible
Restorative Services
6 months 
Simple Extractions 
Adjunctive Services
(Emergency treatment of dental pain for minor procedure, general anesthesia with oral surgery) 
Oral Surgery
(Includes root removal, treatment of abscess) 
18 months 
Prosthodontic Services
(Onlays, crowns, dentures) 
Endodontic Services
(Root canals) 
Periodontal Services
(Includes periodontal cleaning, scaling, root planing) 
This is not a full listing of benefits. If you have questions about a specific benefit, please contact your Anthem Sales Representative. 
And remember, if you need help, we're here to answer your questions. E-mail a Licensed Direct Agent by clicking here, or call 1-800-304-0372, Monday through Thursday from 8:30 to 6:00, and until 4:30 on Friday, or contact your local Anthem Sales Representative. 
Individual Monthly Dental Premiums – Effective June 1, 2008
(These rates are per person and subject to change. Note that there is a one-time $25.00 application fee in addition to premium selected below.) 

Age Band Price
Adult under 50 
Adult 50 or older 
1st child with no adult 
Dependent child - No additional premium is charged for more than six children. 
With a child-only policy, the first child enrolled without an adult is charged the same as an adult under 50. 
Please note that there is a one-time application fee for all applicants. If you meet our eligibility requirements, and we receive your completed application, initial premium, and $25 application fee by the 20th of the month, your earliest coverage effective date will be the first of the following month. After the 20th, the earliest your coverage can begin is on the first of the second following month. Your Anthem Sales Representative has more details.  
For More information:
Policy Terms and What's not Covered


Dental Brochure: Form 900879 (rev. 03/08)

Dental Application: Form AVA1183

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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use