Who are these services for?
Anyone with existing dental benefits at the level provided by Medicaid or the Essential Plan 3 / 4 (or better).
What services are covered?
Everything in the Basic Plan (see above) PLUS implants and orthodontia. The annual limits are such that you can get a full set braces (including all follow-up visits and hardware) and as many as 2-3 implants annually (assuming you don’t have substantial other work done the same year). For full details, check out the Tier II Benefits Summary.
Which services are not covered?
The following services are not covered:
- Cosmetic surgery and treatment unless it is reconstructive surgery caused by trauma, infection, or disease of the involved part.
- Prescription drugs and medicines.
- Services and appliances for the treatment of temporomandibular joint (TMJ) dysfunction.
- Transplantations.
Is there a deductible I have to hit before the health insurance starts paying?
There is a $0 deductible meaning you don’t have to pay anything before the coverage we provide kicks in!
Are there copays or co-insurance?
No. So long as you see an in-network dentist, the plan covers the full expense of all covered services.
What dentists can I see?
You can see any dentist you like with one caveat: As a Preferred Premier Dental Plan, you have access to a network of more than 10,000 dentists and specialists in New York and New Jersey. While you can visit either an in-network or out-of-network dentist, when you visit an in-network dentist, you can be certain that the insurance we provide you with will cover 100% of the set dollar amount for the service or 100% of the bill (depending on the service). When you see an out-of-network dentist, the health insurance provider will pay the full amount they’d pay to an in-network dentist but if your out-of-network dentist charges more than that, you’ll have to pay the difference. Search for an in-network dentist by specialty in your area.