What the Plan Costs and Covers

Benefits At-a-Glance: EmblemHealth FEDVIP Dental Program

Preventive and Diagnostic Services
Covers services meant to maintain good dental health, including exams, X-rays, cleanings and fluoride treatments. Two exams and two cleanings per covered person are payable in a calendar year. Paid in full in-network; Deductible applies to out-of-network benefits only
Intermediate Services, and Periodontal and Endodontic Services
Covers fillings, extractions, denture/crown/bridge repair, emergency treatments, oral surgery and anesthesia/IV sedation; and specialist consultations Paid in full in-network; Deductible applies to out-of-network benefits only
Major Services
Covers root canals, crowns, gingivectomy periodontal surgery, fixed bridgework and dentures Paid in full in-network; Deductible applies to out-of-network benefits only
Implants (includes crowns) $1,400 maximum allowance; Deductible applies to out-of-network benefits only
Calendar Year Deductible
Applies to intermediate and major services received out-of-network only In-network: $0 Individual/$0 Family; Out-of-network: $50 Individual/$150 Family
Maximum Benefit Payout
Annual maximum per covered member (not including orthodontia) Unlimited
Lifetime orthodontia maximum per covered member. (Orthodontia benefits are not available until member is covered under this plan for 12 consecutive months.) $3,000
Out-of-Network Reimbursement
The member pays the difference between EmblemHealth’s payment and the provider’s charge. Refer to the plan’s Preferred Schedule (same as the in-network schedule).

Note that you must live or work in the following counties where we have network providers, in order to be eligible for this program:

  • New York State: all counties
  • New Jersey: Bergen, Essex, Hudson, Middlesex, Monmouth, Morris, Passaic, Somerset, Sussex and Union
  • Pennsylvania: Monroe and Pike
  • Connecticut: Fairfield, Litchfield and New Haven

For complete details about the benefits available through this plan, please read the EmblemHealth FEDVIP Dental Program RI.

For easy access to information about your dental benefits, claim status, benefits eligibility and more, simply visit emblemhealth.com and register for your personal account.