Mothers-to-be should
take special care of their
teeth and gums.
Find out why and then sign up for extra dental benefits –
at no extra cost – using the form below.
Pregnancy and your dental health
If you’re having a baby, you already know how important it is to take care of your body and eat healthy foods. But while
you’re watching what you put in your mouth, you also need to take special care of your mouth, itself ... which includes your
teeth and gums.
Here’s why.
• The United States Surgeon General reports that there is a strong link between the health of a pregnant woman’s mouth
and her overall health.*
• Pregnant women with infections of the gums and mouth (called periodontal disease) may be seven times more likely to
have a baby that’s born too early and too small.**
Your Anthem Blue Cross dental plan helps you take extra good care of your mouth.
Taking care of your teeth and gums is easy and can help keep your mouth free from infection. You should brush and floss
daily, and see your dentist regularly. And while your dental plan most likely provides coverage for preventive care services,
by completing the form below, you can get coverage for an extra dental cleaning (to help keep your teeth healthy) or an
extra periodontal maintenance procedure (to help keep your gums healthy) during your pregnancy.
For a healthy smile, sign up here.
Simply complete the information below and mail, e-mail or fax it to us – whichever is easiest for you.
Mail: Anthem Blue Cross, 233 S. Wacker Drive, Suite 3700, Chicago, Illinois 60606
Attention: Clinical Integration Coordinator
E-mail: YourOralHealth@anthem.com
Fax: 877-261-2131
Dental enrollment form
The extra dental benefit for pregnant members does not apply to all dental plans. Call the customer service number on the back of your identification card
or check your benefits contract to determine if this benefit applies to your dental plan.
Member name: _______________________________________________________________________________________________________________
Member address: _____________________________________________________________________________________________________________
Member phone number: (h) _ _______________________________________________ (w) _ ___________________________________________
Subscriber name: _____________________________________________________________________________________________________________
Subscriber ID number: _ __________________________________________Group (plan) number: _ _____________________________________
Group name: _ __________________________________________________________________________________________
Member signature: ______________________________________________________Today’s date:_______________________________________
I hereby certify that I was pregnant as of the above signature date and will provide proof of such condition if requested by Anthem Blue Cross.
Additionally, upon request, I will provide a written authorization to Anthem Blue Cross to obtain medical records from my provider(s). If such condition
cannot be verified, I will not be eligible for coverage for the additional dental procedures available under this program.
Name of primary doctor: _ ____________________________________________________________________________________________________
Doctor’s phone number: ______________________________________________________________________________________________________
Questions? Just contact the phone number on the back of your Anthem ID card.
*U.S. Department of Health & Human Services, Office of the Surgeon General website: National Call To Action To Promote Oral Health (November, 2001): http://www.surgeongeneral.gov/topics/
oralhealth/nationalcalltoaction.html
**American Academy of Periodontology website: Baby Steps to Healthy Pregnancy and On-Time Delivery (May, 2008): perio.org/consumer/pregnancy.htm
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross
Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross names and symbols are registered marks of the Blue Cross Association.
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