EmblemHealth Preferred Dental

  • Special Feature Major/Orthodontics Options Deductibles (Individual/ Family) Copay Out-of-Network Coverage Annual Maximum (Per Individual) Product Type
    All covered services are at 100% Yes Yes $0 Yes $1,500 PPO

    What are the main ingredients for the perfect dental plan?

    • Full dental coverage — for preventive and complex procedures — from network dentists
    • A robust network of over 8,000 dentists and specialists in New York and New Jersey
    • The freedom to choose an out-of-network dentist
    • Affordable cost sharing and premiums

    How about all of the above! We’ve designed EmblemHealth Preferred Dental with all these great features to make it easy for you to get the care you need when you need it.

    EmblemHealth Preferred Dental is an affordable dental plan that pays for dental services in full.

    Your choice for your needs:

    • EmblemHealth Preferred Dental is available to groups with 101 or more employees.
    • A wide range of employee contribution levels are available, including a voluntary option where the employee pays 100%.
    • Our unique paid-in-full approach for all in-network covered services makes Preferred Dental an attractive voluntary option.
    • Administrative services only (ASO) and flexible funding arrangements are available to large groups. And you have your choice of benefit designs. (See the “What It Covers” tab.)
    • With the rollover maximum feature, you can qualify to rollover dollars for use in the following year.

    EmblemHealth dental plans are underwritten by Group Health Incorporated (GHI). EmblemHealth insurance plans are underwritten by Group Health Incorporated (GHI), HIP Health Plan of New York (HIP) and HIP Insurance Company of New York. Refer to GHI policy form numbers PLD-1103-C, PLD-1104-C et al.

  • Quality Dentists

    EmblemHealth Preferred Dental is based on a strong, stable provider network established in 1988. Our fully-credentialed PPO network consists of more than 8,000 general dentists and specialists in New York and New Jersey.

    And by credentialed, we mean that our dentists meet the requirements of the NCQA—the “Gold Standard” in health plan accreditation. Not every health insurer can say that. We care about the dental care our members get. And we rest a little easier knowing that they are getting care from dentists that meet the toughest quality standards in the nation.

    Savings to Your Group

    We have negotiated reimbursement levels with our dentists and specialists that deliver significant cost savings for our customers. Reduced fees can range from 50% to as much as 70% off of average charges, depending on location. This translates into comprehensive, paid-in-full benefits for your employees, without the usual price tag.

    Plus, with EmblemHealth Preferred Dental, you can see dentists and specialists in the network without pre-selecting a primary care general dentist or specialty referrals.

    Did we mention that members can see any dentist of their choice? It’s true. If a member chooses to go to a dentist outside of the network, they will still be covered, just with higher out-of-pocket expenses.

    Provider Satisfaction

    It’s important to us that we maintain a direct, supportive relationship with the dental community. When we pay our dentists fast and accurately, we show them that we value their time and their care. In turn, they trust that we will be there for them, supporting the care they provide.

    That’s why EmblemHealth has a dedicated dental claims unit, focused on dental claims alone. Through this department, we process over 1 million claims annually. Plus, with over 95% of our claims coming from New York dentists and specialists, we have a unique, focused understanding of New York providers and regional practice patterns. This helps keep us on the pulse of our providers’ needs and expectations.

  • Unique Coverage

    EmblemHealth Preferred Dental covers in-network preventive services in full, just like many other PPO dental plans. But this plan takes coverage several steps further. Once any applicable deductible is met, complex procedures are paid at 100% when performed by network dentists.

    Complex procedures include:

    • Fillings
    • Root canals
    • Wisdom tooth extractions and related IV sedation
    • Periodontal services
    • Repairs to existing crowns, dentures and bridgework

    There are no additional out-of-pocket costs for your employees until applicable plan benefit maximums are met.

    Sample Plan Designs

    Your choice of benefits levels offers maximum flexibility. Each of EmblemHealth’s dental benefit levels can be combined with various deductible and reimbursement options, helping groups to consider a wide range of benefit designs and pricing at the time of purchase or renewal.

      Preventive/Basic* Preventive/Basic
    with Orthodontics
    Type A—Preventive Covers services that encourage good dental health, like exams, X-rays, cleanings and fluoride treatments. 100%/0% coinsurance 100%/0% coinsurance 100%/0% coinsurance
    Type B — Basic Covers emergency treatments, sealants, fillings, simple extractions, specialist consultations, periodontics, many surgical procedures, and crown, denture and bridge repair, as well as Preventive services. 100%/0% coinsurance 100%/0% coinsurance 100%/0% coinsurance
    Type C — Major Covers restorative services, such as dentures, 2- and 3-surface inlays, crowns, veneers, and fixed bridgework, as well as Basic and Preventive services. Not covered 100%/0% coinsurance 100%/0% coinsurance
    Type D — Orthodontics Covers orthodontics (full banding/braces) with separate lifetime maximums. Not covered Not covered Lifetime maximum of $2,000 and 20 months of treatment time
    Calendar Year Deductible $25 individual $50 individual $50 individual
    $75 family $150 family $150 family
    Applicable to type B only Applicable to types B & C Applicable to types B & C
    Annual Maximum $1,000 $1,500 $1,500
    Out-of-Network Reimbursement In-network schedule In-network schedule In-network schedule

    *Available to groups with more than 50 eligible employees.

  • Join the plan that keeps almost a half million members in the New York region smiling.

    EmblemHealth Preferred Dental’s roots in New York State go back for decades. In fact, the program was established in 1988 and was built to meet the needs of employees for the State of New York. The State was looking for a dental program that provided 100% coverage and contained costs. They found it in EmblemHealth Preferred Dental.

    EmblemHealth Preferred Dental has evolved into the unique and popular product it is today. It boasts nearly a half million enrolled employees and their dependents and has grown to proudly serve the dental needs of other groups throughout the state, such as:

    • FEDVIP
    • HEREIU
    • NYC Transit
    • City of Buffalo
    • Erie County
    • NYS Unified Courts System
    • Voluntary NYS Retirees

    Get started today to build the EmblemHealth Preferred Dental coverage that meets the needs of your group.

    To enroll your group today, call us toll free at 1-877-411-3625.

    Or speak directly to John Kobi, Director of Group Sales, for more information. John can be reached at 1-646-447-5038.