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Our two dental plans, the 传统的计划 and 大奖章的计划, are administered by Excellus BlueCross BlueShield and offer you coverage for your dental needs. The chart below details differences between your two plan options. 你也可以 探索费率信息 对于这些计划.

牙科 plans comparison chart

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护理/计划功能类型 传统的计划 大奖章的计划
报道 The 牙科计划 allow you the freedom to see any dentist you choose. 然而, nonparticipating dentists are not obligated to accept Excellus BCBS’s allowed amounts as payment in full and will balance bill any amount in excess of Excellus BCBS’s allowed amounts. It is recommended that you request a Predetermination of 好处 prior to receiving any care expected to exceed $300.
年度扣除 $50 individual/$150 family; applies to classes II, IIA, and III
Maximum benefit per calendar year (per participant) $1,000 applies to classes II, IIA, and III $2,000 applies to classes II, IIA, and III
区域外/网络外

Covered, subject to balance billing
招生 报道 for eligible faculty and staff members is effective the first of the month following your date of appointment or on the date of appointment if it occurs on the first of the month. 报道 for Residents and Fellows is effective the date of hire or appointment.
替代的好处 All covered procedures are subject to Alternative 好处. 好处 will be provided for the procedure carrying the lesser allowable expense, provided that procedure meets acceptable dental standards, 根据医疗需要. If the more expensive procedure is chosen by you or your Dentist and is not medically necessary, you must pay the difference between the plan’s payment and the amount billed by the Dentist.
一级预防服务*

  1. 清洁和口试1
  2. Fluoride treatments covered to age 16
  3. 密封剂覆盖到16岁
  4. 咬翼片x射线2
  5. Full mouth and panorex x-rays
  

 

Plan pays 100% of in-network negotiated rates, no deductible
Class II and IIA—Basic Restorative Services*

  1. 馅料
  2. Simple extraction oral surgery
  3. 口腔外科
  4. 牙髓学
  5. 牙周手术
  

 

Covered at 80%, subject to deductible
Class III—Major Restorative Services*3

  1. 固定可移动假肢
  2. Implants (limited coverage requires preauthorization)4
  3. 镶嵌/镶饰/王冠
  

 

Covered at 15%, subject to deductible

  

 

Covered at 50%, subject to deductible
类IV-Orthodontia *

  1. 类IV-Coinsurance
  2. Braces (dependents to age 19)
  

不包括

  

**Covered at 50%, subject to orthodontia lifetime maximum
($1,500 total to be paid over the course of 2 years)
  1. Covered twice per calendar year
  2. Up to four (4) bitewing films covered per calendar year
  3. Services are reviewed for medical necessity
  4. 好处 for replacement of multiple missing teeth and/or bilaterally missing teeth are allowed as a partial denture

*Contact Excellus BlueCross BlueShield for the full list of covered services.

**招生 in the 大奖章的计划 and orthodontia treatment must be maintained over the course of two years to receive the lifetime maximum ($1,500)

The University reserves the right to modify, 修改, or terminate the Plans at any time, including actions that may affect coverage, 成本分摊, 或者保险福利, as well as benefits that are provided to current and future retirees. This chart provides only a summary of the main features of the plans.

 

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