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Dental Benefit Reimbursement

Non-Medicare Covered Comprehensive Dental Allowance

Reimbursement up to $250 each calendar year for dental non–routine services, diagnostic services, restorative services, endodontics, periodontics, extractions, prosthodontics, other oral/maxillofacial surgery, and other services. Excludes Orthodontics. Excludes silver and/or composite fillings.

Download and fill out the reimbursement form and mail it to the us with an itemized receipt.

Mail to:
Horizon Blue Cross Blue Shield of New Jersey
P.O. Box 1609
Newark, NJ 07101-1609

Itemized receipt must include the dental codes and description of the service rendered. If no codes are provided, your request may be denied. You may submit one or multiple requests for reimbursement up to the $250 limit.

*The $250 reimbursement and any amounts paid out-of-pocket for Non-Medicare Covered Comprehensive Dental Allowance do not count toward your maximum out-of-pocket amount.
*Verify in your Evidence of Coverage (EOC) if this benefit is covered under your plan.

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