Namara Marketplace

2016 QHP Landscape NM Individual Market Dental

State Code

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County Name

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Metal Level

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Issuer Name

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Plan Id (Standard Component)

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Plan Marketing Name

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Plan Type

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Rating Area

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Child Only Offering

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Source

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Customer Service Phone Number Local

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Customer Service Phone Number Toll Free

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Customer Service Phone Number Tty

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Network Url

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Plan Brochure Url

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Summary Of Benefits Url

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Drug Formulary Url

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Routine Dental Services Adult 1

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Basic Dental Care Adult 1

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Major Dental Care Adult 1

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Orthodontia Adult 1

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Dental Check-Up For Children

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Basic Dental Care Child 1

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Major Dental Care Child 1

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Orthodontia Child 1

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Premium Rates

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Premium Child

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Premium Adult Individual Age 21

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Premium Adult Individual Age 27

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Premium Adult Individual Age 30

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Premium Adult Individual Age 40

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Premium Adult Individual Age 50

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Premium Adult Individual Age 60

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Premium Couple 21

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Premium Couple 30

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Premium Couple 40

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Premium Couple 50

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Premium Couple 60

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Couple+1 Child, Age 21

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Couple+1 Child, Age 30

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Couple+1 Child, Age 40

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Couple+1 Child, Age 50

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Couple+2 Children, Age 21

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Couple+2 Children, Age 30

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Couple+2 Children, Age 40

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Couple+2 Children, Age 50

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Couple+3 Or More Children, Age 21

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Couple+3 Or More Children, Age 30

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Couple+3 Or More Children, Age 40

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Couple+3 Or More Children, Age 50

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Individual+1 Child, Age 21

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Individual+1 Child, Age 30

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Individual+1 Child, Age 40

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Individual+1 Child, Age 50

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Individual+2 Children, Age 21

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Individual+2 Children, Age 30

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Individual+2 Children, Age 40

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Individual+2 Children, Age 50

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Individual+3 Or More Children, Age 21

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Individual+3 Or More Children, Age 30

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Individual+3 Or More Children, Age 40

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Individual+3 Or More Children, Age 50

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Standard On Exchange

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Dental Deductible - Individual - Standard

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Dental Deductible - Family - Standard

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Dental Deductible - Family (Per Person) - Standard

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Dental Maximum Out Of Pocket - Individual - Standard

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Dental Maximum Out Of Pocket - Family - Standard

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Dental Maximum Out Of Pocket - Family (Per Person) - Standard

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Routine Dental Services Adult

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Basic Dental Care Adult

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Major Dental Care Adult

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Orthodontia Adult

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Dental Checkup For Children

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Basic Dental Care Child

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Major Dental Care Child

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Orthodontia Child

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NM
Bernalillo
High
Blue Cross Blue Shield of New Mexico
75605NM0430003
BlueCare Dental 4 Kids? 1A
PPO
Rating Area 1
Allows Child-Only
SERFF
1-866-236-1702
1-866-236-1702
1-800-659-8331
http://www.bcbsnm.com/provider_finder/important_info_dental.html
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
X
X
X
X
33.02
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Bernalillo
High
Renaissance Life & Health Insurance Company of America
17911NM0090001
Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)
PPO
Rating Area 1
Allows Child-Only
SERFF
1-800-971-4108
1-800-971-4108
http://www.deltadental.com/DentistSearch/DentistSearchController.ccl
http://www.deltadentalnm.com/NM_Ped_High_2016
http://www.deltadentalnm.com/NM_Ped_High_2016
X
X
X
X
37.53
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Bernalillo
Low
BEST Life and Health Insurance Company
26075NM0020005
BESTOne Plus Silver
PPO
Rating Area 1
Allows Adult and Child-Only
SERFF
1-949-253-4080
1-800-433-0088
1-949-222-2134
http://www.bestlife.com/exchange/dentemax.html
https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Plus-Silver_Plan.pdf
X
X
X
X
X
X
X
20.76
27.32
29.19
29.19
29.19
29.19
29.19
54.64
58.38
58.38
58.38
58.38
75.4
79.14
79.14
79.14
96.16
99.9
99.9
99.9
116.92
120.66
120.66
120.66
48.08
49.95
49.95
49.95
68.84
70.71
70.71
70.71
89.6
91.47
91.47
91.47
75
See Plan Brochure
$75
350
700
350
No Charge
30% Coinsurance after deductible
60% Coinsurance after deductible
Not Covered
No Charge
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Bernalillo
Low
BEST Life and Health Insurance Company
26075NM0020006
BESTOne Basic Silver
PPO
Rating Area 1
Allows Adult and Child-Only
SERFF
1-949-253-4080
1-800-433-0088
1-949-222-2134
http://www.bestlife.com/exchange/dentemax.html
https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Basic-Silver_Plan.pdf
X
X
X
X
X
X
X
20.76
19.98
21.34
21.34
21.34
21.34
21.34
39.96
42.68
42.68
42.68
42.68
60.72
63.44
63.44
63.44
81.48
84.2
84.2
84.2
102.24
104.96
104.96
104.96
40.74
42.1
42.1
42.1
61.5
62.86
62.86
62.86
82.26
83.62
83.62
83.62
75
See Plan Brochure
$75
350
700
350
No Charge
50% Coinsurance after deductible
70% Coinsurance after deductible
Not Covered
No Charge
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Bernalillo
Low
Blue Cross Blue Shield of New Mexico
75605NM0430002
BlueCare Dental? 1B
PPO
Rating Area 1
Allows Adult and Child-Only
SERFF
1-866-236-1702
1-866-236-1702
1-800-659-8331
http://www.bcbsnm.com/provider_finder/important_info_dental.html
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
X
X
X
X
X
X
X
26.86
22.02
22.02
22.02
22.02
22.02
22.02
44.04
44.04
44.04
44.04
44.04
70.9
70.9
70.9
70.9
97.76
97.76
97.76
97.76
124.62
124.62
124.62
124.62
48.88
48.88
48.88
48.88
75.74
75.74
75.74
75.74
102.6
102.6
102.6
102.6
75
$225
$75
350
700
350
10%
30% Coinsurance after deductible
50% Coinsurance after deductible
Not Covered
20%
50% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Bernalillo
Low
Renaissance Life & Health Insurance Company of America
17911NM0060002
Delta Dental Individual PPO, EHB Certified (Exchange)
PPO
Rating Area 1
Allows Adult and Child-Only
SERFF
1-800-971-4108
1-800-971-4108
http://www.deltadental.com/DentistSearch/DentistSearchController.ccl
http://www.deltadentalnm.com/NM_EHB_Low_2016
http://www.deltadentalnm.com/NM_EHB_Low_2016
X
X
X
X
X
X
X
31.11
31.11
18.23
18.23
19.83
25.45
31.26
62.22
36.46
39.66
50.9
62.52
93.33
67.57
70.77
82.01
124.44
98.68
101.88
113.12
155.55
129.79
132.99
144.23
62.22
49.34
50.94
56.56
93.33
80.45
82.05
87.67
124.44
111.56
113.16
118.78
50
$150
$50
350
700
350
20%
40% Coinsurance after deductible
50% Coinsurance after deductible
Not Covered
20%
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Catron
High
Blue Cross Blue Shield of New Mexico
75605NM0430003
BlueCare Dental 4 Kids? 1A
PPO
Rating Area 5
Allows Child-Only
SERFF
1-866-236-1702
1-866-236-1702
1-800-659-8331
http://www.bcbsnm.com/provider_finder/important_info_dental.html
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
X
X
X
X
33.02
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Catron
High
Renaissance Life & Health Insurance Company of America
17911NM0090001
Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)
PPO
Rating Area 5
Allows Child-Only
SERFF
1-800-971-4108
1-800-971-4108
http://www.deltadental.com/DentistSearch/DentistSearchController.ccl
http://www.deltadentalnm.com/NM_Ped_High_2016
http://www.deltadentalnm.com/NM_Ped_High_2016
X
X
X
X
29.46
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Catron
Low
BEST Life and Health Insurance Company
26075NM0020005
BESTOne Plus Silver
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-949-253-4080
1-800-433-0088
1-949-222-2134
http://www.bestlife.com/exchange/dentemax.html
https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Plus-Silver_Plan.pdf
X
X
X
X
X
X
X
18.57
24.44
26.11
26.11
26.11
26.11
26.11
48.88
52.22
52.22
52.22
52.22
67.45
70.79
70.79
70.79
86.02
89.36
89.36
89.36
104.59
107.93
107.93
107.93
43.01
44.68
44.68
44.68
61.58
63.25
63.25
63.25
80.15
81.82
81.82
81.82
75
See Plan Brochure
$75
350
700
350
No Charge
30% Coinsurance after deductible
60% Coinsurance after deductible
Not Covered
No Charge
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Catron
Low
BEST Life and Health Insurance Company
26075NM0020006
BESTOne Basic Silver
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-949-253-4080
1-800-433-0088
1-949-222-2134
http://www.bestlife.com/exchange/dentemax.html
https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Basic-Silver_Plan.pdf
X
X
X
X
X
X
X
18.57
17.87
19.09
19.09
19.09
19.09
19.09
35.74
38.18
38.18
38.18
38.18
54.31
56.75
56.75
56.75
72.88
75.32
75.32
75.32
91.45
93.89
93.89
93.89
36.44
37.66
37.66
37.66
55.01
56.23
56.23
56.23
73.58
74.8
74.8
74.8
75
See Plan Brochure
$75
350
700
350
No Charge
50% Coinsurance after deductible
70% Coinsurance after deductible
Not Covered
No Charge
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Catron
Low
Blue Cross Blue Shield of New Mexico
75605NM0430002
BlueCare Dental? 1B
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-866-236-1702
1-866-236-1702
1-800-659-8331
http://www.bcbsnm.com/provider_finder/important_info_dental.html
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
X
X
X
X
X
X
X
26.86
22.02
22.02
22.02
22.02
22.02
22.02
44.04
44.04
44.04
44.04
44.04
70.9
70.9
70.9
70.9
97.76
97.76
97.76
97.76
124.62
124.62
124.62
124.62
48.88
48.88
48.88
48.88
75.74
75.74
75.74
75.74
102.6
102.6
102.6
102.6
75
$225
$75
350
700
350
10%
30% Coinsurance after deductible
50% Coinsurance after deductible
Not Covered
20%
50% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Catron
Low
Renaissance Life & Health Insurance Company of America
17911NM0060002
Delta Dental Individual PPO, EHB Certified (Exchange)
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-800-971-4108
1-800-971-4108
http://www.deltadental.com/DentistSearch/DentistSearchController.ccl
http://www.deltadentalnm.com/NM_EHB_Low_2016
http://www.deltadentalnm.com/NM_EHB_Low_2016
X
X
X
X
X
X
X
24.42
24.42
14.31
14.31
15.56
19.97
24.54
48.84
28.62
31.12
39.94
49.08
73.26
53.04
55.54
64.36
97.68
77.46
79.96
88.78
122.1
101.88
104.38
113.2
48.84
38.73
39.98
44.39
73.26
63.15
64.4
68.81
97.68
87.57
88.82
93.23
50
$150
$50
350
700
350
20%
40% Coinsurance after deductible
50% Coinsurance after deductible
Not Covered
20%
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Chaves
High
Blue Cross Blue Shield of New Mexico
75605NM0430003
BlueCare Dental 4 Kids? 1A
PPO
Rating Area 5
Allows Child-Only
SERFF
1-866-236-1702
1-866-236-1702
1-800-659-8331
http://www.bcbsnm.com/provider_finder/important_info_dental.html
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
X
X
X
X
33.02
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Chaves
High
Renaissance Life & Health Insurance Company of America
17911NM0090001
Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)
PPO
Rating Area 5
Allows Child-Only
SERFF
1-800-971-4108
1-800-971-4108
http://www.deltadental.com/DentistSearch/DentistSearchController.ccl
http://www.deltadentalnm.com/NM_Ped_High_2016
http://www.deltadentalnm.com/NM_Ped_High_2016
X
X
X
X
29.46
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Chaves
Low
BEST Life and Health Insurance Company
26075NM0020005
BESTOne Plus Silver
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-949-253-4080
1-800-433-0088
1-949-222-2134
http://www.bestlife.com/exchange/dentemax.html
https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Plus-Silver_Plan.pdf
X
X
X
X
X
X
X
18.57
24.44
26.11
26.11
26.11
26.11
26.11
48.88
52.22
52.22
52.22
52.22
67.45
70.79
70.79
70.79
86.02
89.36
89.36
89.36
104.59
107.93
107.93
107.93
43.01
44.68
44.68
44.68
61.58
63.25
63.25
63.25
80.15
81.82
81.82
81.82
75
See Plan Brochure
$75
350
700
350
No Charge
30% Coinsurance after deductible
60% Coinsurance after deductible
Not Covered
No Charge
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Chaves
Low
BEST Life and Health Insurance Company
26075NM0020006
BESTOne Basic Silver
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-949-253-4080
1-800-433-0088
1-949-222-2134
http://www.bestlife.com/exchange/dentemax.html
https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Basic-Silver_Plan.pdf
X
X
X
X
X
X
X
18.57
17.87
19.09
19.09
19.09
19.09
19.09
35.74
38.18
38.18
38.18
38.18
54.31
56.75
56.75
56.75
72.88
75.32
75.32
75.32
91.45
93.89
93.89
93.89
36.44
37.66
37.66
37.66
55.01
56.23
56.23
56.23
73.58
74.8
74.8
74.8
75
See Plan Brochure
$75
350
700
350
No Charge
50% Coinsurance after deductible
70% Coinsurance after deductible
Not Covered
No Charge
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Chaves
Low
Blue Cross Blue Shield of New Mexico
75605NM0430002
BlueCare Dental? 1B
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-866-236-1702
1-866-236-1702
1-800-659-8331
http://www.bcbsnm.com/provider_finder/important_info_dental.html
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
X
X
X
X
X
X
X
26.86
22.02
22.02
22.02
22.02
22.02
22.02
44.04
44.04
44.04
44.04
44.04
70.9
70.9
70.9
70.9
97.76
97.76
97.76
97.76
124.62
124.62
124.62
124.62
48.88
48.88
48.88
48.88
75.74
75.74
75.74
75.74
102.6
102.6
102.6
102.6
75
$225
$75
350
700
350
10%
30% Coinsurance after deductible
50% Coinsurance after deductible
Not Covered
20%
50% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Chaves
Low
Renaissance Life & Health Insurance Company of America
17911NM0060002
Delta Dental Individual PPO, EHB Certified (Exchange)
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-800-971-4108
1-800-971-4108
http://www.deltadental.com/DentistSearch/DentistSearchController.ccl
http://www.deltadentalnm.com/NM_EHB_Low_2016
http://www.deltadentalnm.com/NM_EHB_Low_2016
X
X
X
X
X
X
X
24.42
24.42
14.31
14.31
15.56
19.97
24.54
48.84
28.62
31.12
39.94
49.08
73.26
53.04
55.54
64.36
97.68
77.46
79.96
88.78
122.1
101.88
104.38
113.2
48.84
38.73
39.98
44.39
73.26
63.15
64.4
68.81
97.68
87.57
88.82
93.23
50
$150
$50
350
700
350
20%
40% Coinsurance after deductible
50% Coinsurance after deductible
Not Covered
20%
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Cibola
High
Blue Cross Blue Shield of New Mexico
75605NM0430003
BlueCare Dental 4 Kids? 1A
PPO
Rating Area 5
Allows Child-Only
SERFF
1-866-236-1702
1-866-236-1702
1-800-659-8331
http://www.bcbsnm.com/provider_finder/important_info_dental.html
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
X
X
X
X
33.02
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Cibola
High
Renaissance Life & Health Insurance Company of America
17911NM0090001
Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)
PPO
Rating Area 5
Allows Child-Only
SERFF
1-800-971-4108
1-800-971-4108
http://www.deltadental.com/DentistSearch/DentistSearchController.ccl
http://www.deltadentalnm.com/NM_Ped_High_2016
http://www.deltadentalnm.com/NM_Ped_High_2016
X
X
X
X
29.46
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Cibola
Low
BEST Life and Health Insurance Company
26075NM0020005
BESTOne Plus Silver
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-949-253-4080
1-800-433-0088
1-949-222-2134
http://www.bestlife.com/exchange/dentemax.html
https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Plus-Silver_Plan.pdf
X
X
X
X
X
X
X
18.57
24.44
26.11
26.11
26.11
26.11
26.11
48.88
52.22
52.22
52.22
52.22
67.45
70.79
70.79
70.79
86.02
89.36
89.36
89.36
104.59
107.93
107.93
107.93
43.01
44.68
44.68
44.68
61.58
63.25
63.25
63.25
80.15
81.82
81.82
81.82
75
See Plan Brochure
$75
350
700
350
No Charge
30% Coinsurance after deductible
60% Coinsurance after deductible
Not Covered
No Charge
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Cibola
Low
BEST Life and Health Insurance Company
26075NM0020006
BESTOne Basic Silver
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-949-253-4080
1-800-433-0088
1-949-222-2134
http://www.bestlife.com/exchange/dentemax.html
https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Basic-Silver_Plan.pdf
X
X
X
X
X
X
X
18.57
17.87
19.09
19.09
19.09
19.09
19.09
35.74
38.18
38.18
38.18
38.18
54.31
56.75
56.75
56.75
72.88
75.32
75.32
75.32
91.45
93.89
93.89
93.89
36.44
37.66
37.66
37.66
55.01
56.23
56.23
56.23
73.58
74.8
74.8
74.8
75
See Plan Brochure
$75
350
700
350
No Charge
50% Coinsurance after deductible
70% Coinsurance after deductible
Not Covered
No Charge
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Cibola
Low
Blue Cross Blue Shield of New Mexico
75605NM0430002
BlueCare Dental? 1B
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-866-236-1702
1-866-236-1702
1-800-659-8331
http://www.bcbsnm.com/provider_finder/important_info_dental.html
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
X
X
X
X
X
X
X
26.86
22.02
22.02
22.02
22.02
22.02
22.02
44.04
44.04
44.04
44.04
44.04
70.9
70.9
70.9
70.9
97.76
97.76
97.76
97.76
124.62
124.62
124.62
124.62
48.88
48.88
48.88
48.88
75.74
75.74
75.74
75.74
102.6
102.6
102.6
102.6
75
$225
$75
350
700
350
10%
30% Coinsurance after deductible
50% Coinsurance after deductible
Not Covered
20%
50% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Cibola
Low
Renaissance Life & Health Insurance Company of America
17911NM0060002
Delta Dental Individual PPO, EHB Certified (Exchange)
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-800-971-4108
1-800-971-4108
http://www.deltadental.com/DentistSearch/DentistSearchController.ccl
http://www.deltadentalnm.com/NM_EHB_Low_2016
http://www.deltadentalnm.com/NM_EHB_Low_2016
X
X
X
X
X
X
X
24.42
24.42
14.31
14.31
15.56
19.97
24.54
48.84
28.62
31.12
39.94
49.08
73.26
53.04
55.54
64.36
97.68
77.46
79.96
88.78
122.1
101.88
104.38
113.2
48.84
38.73
39.98
44.39
73.26
63.15
64.4
68.81
97.68
87.57
88.82
93.23
50
$150
$50
350
700
350
20%
40% Coinsurance after deductible
50% Coinsurance after deductible
Not Covered
20%
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Colfax
High
Blue Cross Blue Shield of New Mexico
75605NM0430003
BlueCare Dental 4 Kids? 1A
PPO
Rating Area 5
Allows Child-Only
SERFF
1-866-236-1702
1-866-236-1702
1-800-659-8331
http://www.bcbsnm.com/provider_finder/important_info_dental.html
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
X
X
X
X
33.02
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Colfax
High
Renaissance Life & Health Insurance Company of America
17911NM0090001
Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)
PPO
Rating Area 5
Allows Child-Only
SERFF
1-800-971-4108
1-800-971-4108
http://www.deltadental.com/DentistSearch/DentistSearchController.ccl
http://www.deltadentalnm.com/NM_Ped_High_2016
http://www.deltadentalnm.com/NM_Ped_High_2016
X
X
X
X
29.46
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Colfax
Low
BEST Life and Health Insurance Company
26075NM0020005
BESTOne Plus Silver
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-949-253-4080
1-800-433-0088
1-949-222-2134
http://www.bestlife.com/exchange/dentemax.html
https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Plus-Silver_Plan.pdf
X
X
X
X
X
X
X
18.57
24.44
26.11
26.11
26.11
26.11
26.11
48.88
52.22
52.22
52.22
52.22
67.45
70.79
70.79
70.79
86.02
89.36
89.36
89.36
104.59
107.93
107.93
107.93
43.01
44.68
44.68
44.68
61.58
63.25
63.25
63.25
80.15
81.82
81.82
81.82
75
See Plan Brochure
$75
350
700
350
No Charge
30% Coinsurance after deductible
60% Coinsurance after deductible
Not Covered
No Charge
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Colfax
Low
BEST Life and Health Insurance Company
26075NM0020006
BESTOne Basic Silver
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-949-253-4080
1-800-433-0088
1-949-222-2134
http://www.bestlife.com/exchange/dentemax.html
https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Basic-Silver_Plan.pdf
X
X
X
X
X
X
X
18.57
17.87
19.09
19.09
19.09
19.09
19.09
35.74
38.18
38.18
38.18
38.18
54.31
56.75
56.75
56.75
72.88
75.32
75.32
75.32
91.45
93.89
93.89
93.89
36.44
37.66
37.66
37.66
55.01
56.23
56.23
56.23
73.58
74.8
74.8
74.8
75
See Plan Brochure
$75
350
700
350
No Charge
50% Coinsurance after deductible
70% Coinsurance after deductible
Not Covered
No Charge
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Colfax
Low
Blue Cross Blue Shield of New Mexico
75605NM0430002
BlueCare Dental? 1B
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-866-236-1702
1-866-236-1702
1-800-659-8331
http://www.bcbsnm.com/provider_finder/important_info_dental.html
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
X
X
X
X
X
X
X
26.86
22.02
22.02
22.02
22.02
22.02
22.02
44.04
44.04
44.04
44.04
44.04
70.9
70.9
70.9
70.9
97.76
97.76
97.76
97.76
124.62
124.62
124.62
124.62
48.88
48.88
48.88
48.88
75.74
75.74
75.74
75.74
102.6
102.6
102.6
102.6
75
$225
$75
350
700
350
10%
30% Coinsurance after deductible
50% Coinsurance after deductible
Not Covered
20%
50% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Colfax
Low
Renaissance Life & Health Insurance Company of America
17911NM0060002
Delta Dental Individual PPO, EHB Certified (Exchange)
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-800-971-4108
1-800-971-4108
http://www.deltadental.com/DentistSearch/DentistSearchController.ccl
http://www.deltadentalnm.com/NM_EHB_Low_2016
http://www.deltadentalnm.com/NM_EHB_Low_2016
X
X
X
X
X
X
X
24.42
24.42
14.31
14.31
15.56
19.97
24.54
48.84
28.62
31.12
39.94
49.08
73.26
53.04
55.54
64.36
97.68
77.46
79.96
88.78
122.1
101.88
104.38
113.2
48.84
38.73
39.98
44.39
73.26
63.15
64.4
68.81
97.68
87.57
88.82
93.23
50
$150
$50
350
700
350
20%
40% Coinsurance after deductible
50% Coinsurance after deductible
Not Covered
20%
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Curry
High
Blue Cross Blue Shield of New Mexico
75605NM0430003
BlueCare Dental 4 Kids? 1A
PPO
Rating Area 5
Allows Child-Only
SERFF
1-866-236-1702
1-866-236-1702
1-800-659-8331
http://www.bcbsnm.com/provider_finder/important_info_dental.html
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
X
X
X
X
33.02
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Curry
High
Renaissance Life & Health Insurance Company of America
17911NM0090001
Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)
PPO
Rating Area 5
Allows Child-Only
SERFF
1-800-971-4108
1-800-971-4108
http://www.deltadental.com/DentistSearch/DentistSearchController.ccl
http://www.deltadentalnm.com/NM_Ped_High_2016
http://www.deltadentalnm.com/NM_Ped_High_2016
X
X
X
X
29.46
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Curry
Low
BEST Life and Health Insurance Company
26075NM0020005
BESTOne Plus Silver
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-949-253-4080
1-800-433-0088
1-949-222-2134
http://www.bestlife.com/exchange/dentemax.html
https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Plus-Silver_Plan.pdf
X
X
X
X
X
X
X
18.57
24.44
26.11
26.11
26.11
26.11
26.11
48.88
52.22
52.22
52.22
52.22
67.45
70.79
70.79
70.79
86.02
89.36
89.36
89.36
104.59
107.93
107.93
107.93
43.01
44.68
44.68
44.68
61.58
63.25
63.25
63.25
80.15
81.82
81.82
81.82
75
See Plan Brochure
$75
350
700
350
No Charge
30% Coinsurance after deductible
60% Coinsurance after deductible
Not Covered
No Charge
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Curry
Low
BEST Life and Health Insurance Company
26075NM0020006
BESTOne Basic Silver
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-949-253-4080
1-800-433-0088
1-949-222-2134
http://www.bestlife.com/exchange/dentemax.html
https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Basic-Silver_Plan.pdf
X
X
X
X
X
X
X
18.57
17.87
19.09
19.09
19.09
19.09
19.09
35.74
38.18
38.18
38.18
38.18
54.31
56.75
56.75
56.75
72.88
75.32
75.32
75.32
91.45
93.89
93.89
93.89
36.44
37.66
37.66
37.66
55.01
56.23
56.23
56.23
73.58
74.8
74.8
74.8
75
See Plan Brochure
$75
350
700
350
No Charge
50% Coinsurance after deductible
70% Coinsurance after deductible
Not Covered
No Charge
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Curry
Low
Blue Cross Blue Shield of New Mexico
75605NM0430002
BlueCare Dental? 1B
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-866-236-1702
1-866-236-1702
1-800-659-8331
http://www.bcbsnm.com/provider_finder/important_info_dental.html
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
X
X
X
X
X
X
X
26.86
22.02
22.02
22.02
22.02
22.02
22.02
44.04
44.04
44.04
44.04
44.04
70.9
70.9
70.9
70.9
97.76
97.76
97.76
97.76
124.62
124.62
124.62
124.62
48.88
48.88
48.88
48.88
75.74
75.74
75.74
75.74
102.6
102.6
102.6
102.6
75
$225
$75
350
700
350
10%
30% Coinsurance after deductible
50% Coinsurance after deductible
Not Covered
20%
50% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Curry
Low
Renaissance Life & Health Insurance Company of America
17911NM0060002
Delta Dental Individual PPO, EHB Certified (Exchange)
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-800-971-4108
1-800-971-4108
http://www.deltadental.com/DentistSearch/DentistSearchController.ccl
http://www.deltadentalnm.com/NM_EHB_Low_2016
http://www.deltadentalnm.com/NM_EHB_Low_2016
X
X
X
X
X
X
X
24.42
24.42
14.31
14.31
15.56
19.97
24.54
48.84
28.62
31.12
39.94
49.08
73.26
53.04
55.54
64.36
97.68
77.46
79.96
88.78
122.1
101.88
104.38
113.2
48.84
38.73
39.98
44.39
73.26
63.15
64.4
68.81
97.68
87.57
88.82
93.23
50
$150
$50
350
700
350
20%
40% Coinsurance after deductible
50% Coinsurance after deductible
Not Covered
20%
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
De Baca
High
Blue Cross Blue Shield of New Mexico
75605NM0430003
BlueCare Dental 4 Kids? 1A
PPO
Rating Area 5
Allows Child-Only
SERFF
1-866-236-1702
1-866-236-1702
1-800-659-8331
http://www.bcbsnm.com/provider_finder/important_info_dental.html
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
X
X
X
X
33.02
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
De Baca
High
Renaissance Life & Health Insurance Company of America
17911NM0090001
Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)
PPO
Rating Area 5
Allows Child-Only
SERFF
1-800-971-4108
1-800-971-4108
http://www.deltadental.com/DentistSearch/DentistSearchController.ccl
http://www.deltadentalnm.com/NM_Ped_High_2016
http://www.deltadentalnm.com/NM_Ped_High_2016
X
X
X
X
29.46
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
De Baca
Low
BEST Life and Health Insurance Company
26075NM0020005
BESTOne Plus Silver
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-949-253-4080
1-800-433-0088
1-949-222-2134
http://www.bestlife.com/exchange/dentemax.html
https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Plus-Silver_Plan.pdf
X
X
X
X
X
X
X
18.57
24.44
26.11
26.11
26.11
26.11
26.11
48.88
52.22
52.22
52.22
52.22
67.45
70.79
70.79
70.79
86.02
89.36
89.36
89.36
104.59
107.93
107.93
107.93
43.01
44.68
44.68
44.68
61.58
63.25
63.25
63.25
80.15
81.82
81.82
81.82
75
See Plan Brochure
$75
350
700
350
No Charge
30% Coinsurance after deductible
60% Coinsurance after deductible
Not Covered
No Charge
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
De Baca
Low
BEST Life and Health Insurance Company
26075NM0020006
BESTOne Basic Silver
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-949-253-4080
1-800-433-0088
1-949-222-2134
http://www.bestlife.com/exchange/dentemax.html
https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Basic-Silver_Plan.pdf
X
X
X
X
X
X
X
18.57
17.87
19.09
19.09
19.09
19.09
19.09
35.74
38.18
38.18
38.18
38.18
54.31
56.75
56.75
56.75
72.88
75.32
75.32
75.32
91.45
93.89
93.89
93.89
36.44
37.66
37.66
37.66
55.01
56.23
56.23
56.23
73.58
74.8
74.8
74.8
75
See Plan Brochure
$75
350
700
350
No Charge
50% Coinsurance after deductible
70% Coinsurance after deductible
Not Covered
No Charge
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
De Baca
Low
Blue Cross Blue Shield of New Mexico
75605NM0430002
BlueCare Dental? 1B
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-866-236-1702
1-866-236-1702
1-800-659-8331
http://www.bcbsnm.com/provider_finder/important_info_dental.html
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
X
X
X
X
X
X
X
26.86
22.02
22.02
22.02
22.02
22.02
22.02
44.04
44.04
44.04
44.04
44.04
70.9
70.9
70.9
70.9
97.76
97.76
97.76
97.76
124.62
124.62
124.62
124.62
48.88
48.88
48.88
48.88
75.74
75.74
75.74
75.74
102.6
102.6
102.6
102.6
75
$225
$75
350
700
350
10%
30% Coinsurance after deductible
50% Coinsurance after deductible
Not Covered
20%
50% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
De Baca
Low
Renaissance Life & Health Insurance Company of America
17911NM0060002
Delta Dental Individual PPO, EHB Certified (Exchange)
PPO
Rating Area 5
Allows Adult and Child-Only
SERFF
1-800-971-4108
1-800-971-4108
http://www.deltadental.com/DentistSearch/DentistSearchController.ccl
http://www.deltadentalnm.com/NM_EHB_Low_2016
http://www.deltadentalnm.com/NM_EHB_Low_2016
X
X
X
X
X
X
X
24.42
24.42
14.31
14.31
15.56
19.97
24.54
48.84
28.62
31.12
39.94
49.08
73.26
53.04
55.54
64.36
97.68
77.46
79.96
88.78
122.1
101.88
104.38
113.2
48.84
38.73
39.98
44.39
73.26
63.15
64.4
68.81
97.68
87.57
88.82
93.23
50
$150
$50
350
700
350
20%
40% Coinsurance after deductible
50% Coinsurance after deductible
Not Covered
20%
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Dona Ana
High
Blue Cross Blue Shield of New Mexico
75605NM0430003
BlueCare Dental 4 Kids? 1A
PPO
Rating Area 3
Allows Child-Only
SERFF
1-866-236-1702
1-866-236-1702
1-800-659-8331
http://www.bcbsnm.com/provider_finder/important_info_dental.html
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
X
X
X
X
33.02
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Dona Ana
High
Renaissance Life & Health Insurance Company of America
17911NM0090001
Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)
PPO
Rating Area 3
Allows Child-Only
SERFF
1-800-971-4108
1-800-971-4108
http://www.deltadental.com/DentistSearch/DentistSearchController.ccl
http://www.deltadentalnm.com/NM_Ped_High_2016
http://www.deltadentalnm.com/NM_Ped_High_2016
X
X
X
X
29
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Dona Ana
Low
BEST Life and Health Insurance Company
26075NM0020005
BESTOne Plus Silver
PPO
Rating Area 3
Allows Adult and Child-Only
SERFF
1-949-253-4080
1-800-433-0088
1-949-222-2134
http://www.bestlife.com/exchange/dentemax.html
https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Plus-Silver_Plan.pdf
X
X
X
X
X
X
X
17.72
23.31
24.91
24.91
24.91
24.91
24.91
46.62
49.82
49.82
49.82
49.82
64.34
67.54
67.54
67.54
82.06
85.26
85.26
85.26
99.78
102.98
102.98
102.98
41.03
42.63
42.63
42.63
58.75
60.35
60.35
60.35
76.47
78.07
78.07
78.07
75
See Plan Brochure
$75
350
700
350
No Charge
30% Coinsurance after deductible
60% Coinsurance after deductible
Not Covered
No Charge
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Dona Ana
Low
BEST Life and Health Insurance Company
26075NM0020006
BESTOne Basic Silver
PPO
Rating Area 3
Allows Adult and Child-Only
SERFF
1-949-253-4080
1-800-433-0088
1-949-222-2134
http://www.bestlife.com/exchange/dentemax.html
https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Basic-Silver_Plan.pdf
X
X
X
X
X
X
X
17.72
17.05
18.21
18.21
18.21
18.21
18.21
34.1
36.42
36.42
36.42
36.42
51.82
54.14
54.14
54.14
69.54
71.86
71.86
71.86
87.26
89.58
89.58
89.58
34.77
35.93
35.93
35.93
52.49
53.65
53.65
53.65
70.21
71.37
71.37
71.37
75
See Plan Brochure
$75
350
700
350
No Charge
50% Coinsurance after deductible
70% Coinsurance after deductible
Not Covered
No Charge
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Dona Ana
Low
Blue Cross Blue Shield of New Mexico
75605NM0430002
BlueCare Dental? 1B
PPO
Rating Area 3
Allows Adult and Child-Only
SERFF
1-866-236-1702
1-866-236-1702
1-800-659-8331
http://www.bcbsnm.com/provider_finder/important_info_dental.html
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
X
X
X
X
X
X
X
26.86
22.02
22.02
22.02
22.02
22.02
22.02
44.04
44.04
44.04
44.04
44.04
70.9
70.9
70.9
70.9
97.76
97.76
97.76
97.76
124.62
124.62
124.62
124.62
48.88
48.88
48.88
48.88
75.74
75.74
75.74
75.74
102.6
102.6
102.6
102.6
75
$225
$75
350
700
350
10%
30% Coinsurance after deductible
50% Coinsurance after deductible
Not Covered
20%
50% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Dona Ana
Low
Renaissance Life & Health Insurance Company of America
17911NM0060002
Delta Dental Individual PPO, EHB Certified (Exchange)
PPO
Rating Area 3
Allows Adult and Child-Only
SERFF
1-800-971-4108
1-800-971-4108
http://www.deltadental.com/DentistSearch/DentistSearchController.ccl
http://www.deltadentalnm.com/NM_EHB_Low_2016
http://www.deltadentalnm.com/NM_EHB_Low_2016
X
X
X
X
X
X
X
24.04
24.04
14.08
14.08
15.32
19.66
24.15
48.08
28.16
30.64
39.32
48.3
72.12
52.2
54.68
63.36
96.16
76.24
78.72
87.4
120.2
100.28
102.76
111.44
48.08
38.12
39.36
43.7
72.12
62.16
63.4
67.74
96.16
86.2
87.44
91.78
50
$150
$50
350
700
350
20%
40% Coinsurance after deductible
50% Coinsurance after deductible
Not Covered
20%
40% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Eddy
High
Blue Cross Blue Shield of New Mexico
75605NM0430003
BlueCare Dental 4 Kids? 1A
PPO
Rating Area 5
Allows Child-Only
SERFF
1-866-236-1702
1-866-236-1702
1-800-659-8331
http://www.bcbsnm.com/provider_finder/important_info_dental.html
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf
X
X
X
X
33.02
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%
NM
Eddy
High
Renaissance Life & Health Insurance Company of America
17911NM0090001
Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)
PPO
Rating Area 5
Allows Child-Only
SERFF
1-800-971-4108
1-800-971-4108
http://www.deltadental.com/DentistSearch/DentistSearchController.ccl
http://www.deltadentalnm.com/NM_Ped_High_2016
http://www.deltadentalnm.com/NM_Ped_High_2016
X
X
X
X
29.46
50
$150
$50
350
700
350
Not Covered
Not Covered
Not Covered
Not Covered
No Charge
20% Coinsurance after deductible
50% Coinsurance after deductible
50%

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