Dental Plan Administrator Change, October 1, 2024
The NYS Dental Plan Administrator will change from EmblemHealth to Anthem, effective October 1, 2024. The level of benefit is governed by the collective bargaining agreement, including enhancements achieved during the negotiation of the 2019-2023 PEF/State Agreement, such as a higher annual maximum allowance of $3,000 per person, an increase to $3,000 for the orthodontic lifetime maximum per child, inclusion of a $600 implant allowance, and long overdue coverage for precious/upgraded metal fillings. These previously negotiated enhanced contractual benefits will continue.
The Department of Civil Service plans to send out the following mailings to NYSHIP dental plan enrollees:
NYS Dental Plan Administrator Change Letter
In July, the Department of Civil Service will mail this letter to enrollees’ homes. This letter will explain the change to Anthem and will highlight how enrollees can access and search the applicable Anthem Blue Cross network of dental providers.
Anthem Blue Cross NYS Dental Plan Benefit Documents and Benefit Card
In September, enrollees will receive a welcome letter from Anthem Blue Cross, which will include their new benefit card along with information on how to access benefit information and documents online through a secure member portal.
Dental providers interested in joining the Anthem NYSHIP network can call 1-866-947-9398 to speak to a designated Anthem representative. As PEF receives further information, we will update membership.
Dental Stipend
Pursuant to the Dental Stipend Side Letter contained in the 2023-2026 PEF/State Agreement. The side letter provides for a $400 payment each fiscal year to eligible PS&T members until the State enters into a new dental services contract. There will be a total of two $400 payments, as The State will be entering into a new dental services contract October 1, 2024.
First Dental Stipend: To be eligible, employees must have been in the PS&T unit and enrolled in the NYSHIP Dental Plan having completed the applicable waiting period on July 28, 2023.
Administration Payroll: check dated March 13, 2024.
Institution Payroll: check dated March 21, 2024.
Second Dental Stipend: To be eligible, employees must have been in the PS&T unit on April 1, 2024, and enrolled in the NYSHIP Dental Plan having completed the 28-day waiting period on or before April 1, 2024.
Administration Payroll: check dated May 22, 2024.
Institution Payroll: check dated May 30, 2024.
For seasonal and temporary employees who are employed or are expected to be employed for at least six months, the agencies must submit information to OSC, and it is possible that payments for these members may be processed in later checks.
EmblemHealth Albany Family Dental Practice Closure
It has been brought to PEFs attention, that as of Wednesday, February 7th, the EmblemHealth Family Dental Practices at the Empire State Plaza Concourse, and 1873 Western Avenue will be permanently closing April 30th, 2024. This is not a notification stating that EmblemHealth is closing as a whole. This is a notification of just the two practices that are closing. For further information, you may contact the following: EmblemHealth: 1-800-947-0101 or The Department of Civil Service: 1-800-833-4344.
Letters notifying current patients about the 4/30/24 closures went out at the end of January, early February, giving the required 90-day notice of the closures to patients. The letter recommends that patients should start looking for a new dentist and to contact them prior to 4/30/24 to request any important copies of information pertaining to your dental records for your personal files or to give to your new provider. The offices have confirmed that they are reviewing all outstanding clinical work and that patients will be scheduled so that all treatment plans already in place will be completed prior to the closing date of 4/30/24.
New Vision/Dental Eligibility for Dependents to Age 26
Effective January 1, 2024, in accordance with the 2023-2026 PEF/State Agreement, dependents up to age 26 are now eligible for Dental and Vision benefits, regardless of student status. Coverage will end the first of the month following their 26th birthday.
- If a PEF member with an eligible dependent up to age 26 did not receive a notice in November 2023 from Dept. of Civil Service (DCS) that the dependent was auto enrolled, then the member will need to reach out directly to the agency Health Benefit Administrator (HBA/HR Department) to complete the necessary enrollment paperwork.
- If a PEF member received notification of a dependent that should not have been auto enrolledduring this process, the member will need to reach out directly to the agency Health Benefit
- COBRA Eligibility: Dependents being removed will automatically receive a COBRA application from DCS. Deadlines noted on the application must be adhered to. For more information contact DCS at 1-800-833-4344 and select the COBRA prompt.
Emblemhealth Dental Access Enhancement Program, Single Case Agreement
Single Case Agreements are now available under the NYSHIP Dental Plan. In an effort to increase access to network benefits available under the NYSHIP Dental Program currently administered by EmblemHealth, the State has advised PEF that members can reduce their out-of-pocket expenses through a Single Case Agreement (SCA).
If no participating providers are available for emergency or routine dental care, EmblemHealth can ensure a dental service is provided at the in-network level of benefits with a non-participating provider through a single case agreement; this applies when clinically appropriate, or to address access issues to dentists and specialists, and approval must be obtained prior to receiving treatment by calling Emblem Customer Service at 1-800-947-0101.
The Dental Plan’s network team will coordinate care with a non-participating provider when necessary, and the member will only be responsible for the in-network cost for the arranged service. If a provider is not willing to accept direct payment from Emblem as part of the SCA, Emblem guarantees members will be reimbursed for the provider’s billed amount, up to the maximum allowance according to the Certificate of Insurance.
If any members encounter problems with the SCA program, please contact the PEF Health Benefits Administrator at (800) 342-4306, ext. 283.
EmblemHealth Customer Service: 1-800-947-0101
Out-of-Network Claims: (OON Claims Form)
EmblemHealth Dental Claims
PO Box 2838
New York, NY, 10116-2838
Useful Dental Links:
NYS Dental Plan Certificate of Insurance
NYS Dental Plan Certificate of Insurance – PEF Attachment
NYS Dental Plan Certificate of Insurance – PEF Rider Attachment
American Association of Orthodontists
American Dental Association
American Academy of Periodontology
American Academy of Pediatric Dentistry