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 mouth
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 and Blue Shield 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 fill out the form below and mail, e-mail or fax it to us – whichever is easiest for you.
Mail: Anthem Dental Claims, Attention: Clinical Integration Coordinator, P.O. Box 1115, Minneapolis, MN 55440-1115
E-mail: enroll@anthemdentaladmin.com
Fax:
1-800-821-5946
Dental enrollment form
Member name: _______________________________________________________________________________________________
Member address: _____________________________________________________________________________________________
Member phone number: (h) ____________________________________
(w) _______________________________________
Expected Due Date: _________________________________________________________________________
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 and Blue Shield.
Additionally, upon request, I will provide a written authorization to Anthem Blue Cross and Blue Shield 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 care physician (PCP): __________________________________________________________
Phone number of PCP: ________________________________________________________________________________________
Questions? Just call the customer service 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 and Blue Shield is the trade name of Community Insurance Company. Independent licensee 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.
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