2018 Pediatric & Adult/Family Dental Plans

 

BlueShield of Northeastern New York offers stand-alone pediatric and adult/family dental plans for small groups. Our plans provide essential health benefits to ensure members receive comprehensive oral health coverage through our own dental network. 

  • Pediatric Dental is an Essential Health Benefit as outlined in the Affordable Care Act 
  • Groups can choose one Blue Value dental plan to offer their employees in addition to Blue Pediatric dental
  • Blue Value dental plans include Blue Pediatric dental benefits and coverage for adults and adult dependents aged 19 to 26 years.
  • Flexibility to see out-of-network dentists.

View all Pediatric and Adult Dental Plans

View Blue Pediatric Dental

View Blue Value Dental 1

View Blue Value Dental 2

View Blue Value Dental 3

 

Looking for a dentist?

Use our Find a Doctor tool to find a dentist. You can search by specialty, zip code, city or state. Just select 'Dental Providers' under "My Health Plan" in the navigation to begin your search.

 

Dental Benefits Blue Pediatric Dental* (PPO) Blue Value Dental 1* (PPO)
Blue Value Dental 2 (PPO)
Blue Value Dental 3*** (PPO)
Benefits Children to age 19 years Adult/Family** Adult/Family** Adult/Family**  
Deductible (embedded) N/A $50 per member/$150 family maximum 

Applies to basic restorative & major dental services
$50 per member/$150 family maximum

Applies to basic restorative & major dental services 
$50 per member/$150 family

Applies to basic restorative & major dental services
 
Annual benefit maximum N/A $750 per member per plan year $1,250 per member per plan year $1,500 per member per plan year  
Out-of-pocket maximum $350 - one child
$700 - two or more children (per plan year)
N/A N/A N/A  
Orthodontic lifetime maximum
(pediatric and adult cosmetic, routine braces)
N/A N/A N/A $1,000 per member per lifetime  
Preventive/Diagnostic Care
(exams, cleanings, x-rays)
$20 copay per visit $0 copay per visit $0 copay per visit $0 copay per visit  
Basic restorative
(fillings, extractions, periodontics, endodontics)
50% coinsurance 50% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible
Major dental
(bridges, crowns, dentures)
50% coinsurance 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible

Orthodontics



50% coinsurance
(medically necessary only; routine braces not covered), not subject to out-of-pocket max
 
N/A
 
N/A
 

50% coinsurance
(cosmetic orthodonics for children and adults), subject to lifetime maximum
 
Monthly Premium (Region 1 and 7)
$21.41  per child
$20.45 (subscriber)
$40.90 (subscriber & spouse/domestic partner)
$53.87 (subscriber & child(ren))
$83.77 (family)

$27.33 (subscriber)
$54.66 (subscriber &spouse/domestic partner)
$63.89 (subscriber & child(ren))
$102.38 (family)

$31.55 (subscriber)
$63.10 (subscriber & spouse/domestic partner)
$72.60 (subscriber & child(ren))
$116.82 (family)
         
 
 





   
 

 

 

 

Note: Members can receive dental services from a provider who does not participate in the BlueCross BlueShield contracted network of providers. Out-of-network services are reimbursed at 100% of the in-network fee schedule and the non-participating provider may balance bill the member for the remainder.

*Available on SHOP

**Blue Pediatric Dental benefits and cost-sharing are included in all Blue Value Dental plans. Blue Value Dental plans also cover adult dependents aged 19 to 26 years.

***Blue Value Dental 3 includes coverage for children up to age 19 for medically necessary orthodontics subject to an out-of-pocket maximum (see Blue Pediatric Benefits) and cosmetic orthodontics (routine braces) subject to a lifetime maximum per member. Adults and adult dependents have coverage for cosmetic orthodontics (routine braces) subject to a lifetime maximum per member. 

2018 Dental Plan Contracts

 

Small Group OFF Exchange Contracts

Small Group ON Exchange Contracts

2017 Pediatric & Adult/Family Dental Plans

 

BlueShield of Northeastern New York offers stand-alone pediatric and adult/family dental plans for small groups administered by us. Our plans provide essential health benefits to ensure members receive comprehensive oral health coverage through our own dental network. 

  • New for 2017 - Blue Value Dental 3, a richer plan with coverage for cosmetic orthodontics (routine braces) for children and adults
  • Pediatric Dental is an Essential Health Benefit as outlined in the Affordable Care Act 
  • Groups can choose one Blue Value dental plan to offer their employees in addition to Blue Pediatric dental

View all Pediatric and Adult Dental Plans

View Blue Pediatric Dental

View Blue Value Dental 1

View Blue Value Dental 2

View Blue Value Dental 3


Looking for a dentist?

Use our Find a Doctor tool to find a dentist. You can search by specialty, zip code, city or state. Just select 'Dental Providers' under "My Health Plan" in the navigation to begin your search.

 

Dental benefits Blue Pediatric Dental* (PPO) Blue Value Dental 1* (PPO)
Blue Value Dental 2 (PPO)
Blue Value Dental 3*** (PPO)
Monthly Premium (Region 1 & 7) $21.06 (per child) $20.34 (one adult)
$40.68 (two adults)
$52.48 (subscriber and child(ren))
$83.98 (family)
$27.31 (one adult)
$54.62 (two adults)
$63.31 (subscriber and child(ren))
$102.93 (family)
$31.47 (one adult)
$62.94 (two adults)
$71.59 (subscriber and child(ren))
$116.73 (family)
Benefits Children to age 19 Adult/Family**
Adult/Family** Adult/Family**
Deductible (embedded) N/A $50 per member/$150 family maximum (per plan year)
$50 per member/$150 family maximum
(per plan year)
$50 per member/$150 family maximum
(per plan year)
Preventive/diagnostic care
(exam, cleaning, X-rays)
$20 copayment $0 copayment $0 copayment $0 copayment
Basic restorative
(fillings, extractions, periodontics, endodontics)
50% coinsurance 50% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible
Major dental
(prosthodontics, crowns, dentures)
50% coinsurance 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible
Orthodontic
50% coinsurance
(medically necessary only; routine braces not covered), subject to out-of-pocket max
Not covered Not covered 50% coinsurance 
(cosmetic orthodontics for children and adults), subject to lifetime maximum
Annual maximum N/A $750 per member, per plan year $1,250 per member, per plan year $1,500 per member, per plan year
Out-of-pocket maximum $350 - 1 child
$700 - 2 or more children (per plan year)
N/A N/A N/A
         
 
 

 

 

 

Non-participating provider services are not covered except as required for emergency care.

Note: Members can receive dental services from a provider who does not participate in the BlueShield contracted network of providers. Out-of-network services are reimbursed at 100% of the in-network fee schedule and the non-participating provider may balance bill the member for the remainder.

*Available on SHOP

**Blue Pediatric Dental benefits and cost-sharing are included in all Blue Value Dental plans. Blue Value Dental plans also cover adult dependents aged 19 to 26 years.

***Blue Value Dental 3 includes coverage for children up to age 19 for medically necessary orthodontics subject to an out-of-pocket maximum (see Blue Pediatric Benefits) and cosmetic orthodontics (routine braces) subject to a lifetime maximum per member. Adults and adult dependents have coverage for cosmetic orthodontics (routine braces) subject to a lifetime maximum per member.

2016 Stand Alone Pediatric & Adult Dental Plans

 

BlueShield of Northeastern New York offers stand-alone pediatric and adult dental plans for small groups. Our plans provide essential health benefits to ensure members receive comprehensive oral health coverage. We partner with and utilize the HealthPlex network to service our Adult and Pediatric plans. HealthPlex is the largest dental benefits administrator in New York. These plans will no longer be available in 2016.


View Pediatric Dental Overview Region 1
View Pediatric Dental Overview Region 7

View Adult Dental Overview

 

Looking for a dentist?

Use our Find a Doctor tool to find a dentist. You can search by specialty, zip code, city or state. Just select 'Dental Providers' under "My Health Plan" in the navigation to begin your search.

 

  Blue Pediatric Dental Blue Value Dental
Monthly Premium $20.91 (per child)
For more than one child,
multiply rate by number of children
$14.74 (employee)
$30.22 (employee & spouse/domestic partner)
  $33.17 (employee & children)
$53.06 (family)
Deductible None $50 benefit specific deductible (individual)
Out-of-pocket Limt $350 one child/$700 multiple children Unlimited
Benefit maximum N/A $750 per member, per plan year
Preventive/Routine Care
*One dental exam & one cleaning per
six month period
$20 copayment per preventive/diagnostic visit for services including:
       Dental exam
       Cleaning
       Topical fluoride
       Sealants
       Space maintainers
       Diagnostic x-rays

   50% coinsurance for:
       Simple extractions and routine dental surgery
       Fillings
       Crowns
       Other restorative materials
$0 copayment per preventive/diagnostic visit for services including:
       Dental exam
       Cleaning
       Diagnostic x-rays

50% coinsurance after deductible for:
       Simple extractions and routine dental surgery
       Fillings
       Denture and bridge repair
       Periodontics
Major Dental
(periodontics & endodontics)
50% coinsurance 50% coinsurance after deductible
Orthodontic
50% coinsurance 50% coinsurance after deductible
  Non-participating provider services are not covered except as required for emergency care Non-participating provider services are not covered except as required for emergency care.
     
     
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Non-participating provider services are not covered except as required for emergency care.

*All children under the age of 19 enrolled in Blue Value Dental will be covered under Blue Pediatric Dental in order to meet essential health benefit requirements.