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Dental Plans

Our two dental plans, the Traditional Plan and Medallion Plan, are administered by Excellus BlueCross BlueShield and offer you coverage for your dental needs. The chart below details differences between your two plan options. You can also explore rate information for these plans.

Dental plans comparison chart

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Type of Care / Plan Features Traditional Plan Medallion Plan
Coverage The Dental Plans allow you the freedom to see any dentist you choose. However, 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 Benefits prior to receiving any care expected to exceed $300.
Annual deductible $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
Out of area / out of network

Covered, subject to balance billing

Enrollment Coverage 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. Coverage for Residents and Fellows is effective the date of hire or appointment.
Alternative benefits All covered procedures are subject to Alternative Benefits. Benefits will be provided for the procedure carrying the lesser allowable expense, provided that procedure meets acceptable dental standards, subject to medical necessity. 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.
Class I—Preventive Services*

  1. Cleanings and oral exams1
  2. Fluoride treatments covered to age 16
  3. Sealants
  4. Bitewing x-rays1
  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. Fillings
  2. Simple extraction oral surgery
  3. Oral surgery
  4. Endodontics
  5. Periodontal surgery
 

 

Covered at 80%, subject to deductible

Class III—Major Restorative Services*2

  1. Fixed removable prosthetics
  2. Implants (limited coverage requires preauthorization)3
  3. Inlays / onlay / crowns
 

 

Covered at 15%, subject to deductible

 

 

Covered at 50%, subject to deductible

Class IV—Orthodontia*

  1. Class IV—Coinsurance
  2. Braces (dependents to age 19)
 

Not Covered

 

**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. Services are reviewed for medical necessity.
  3. Benefits 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.

**Enrollment in the Medallion Plan 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, amend, or terminate the Plans at any time, including actions that may affect coverage, cost sharing, or covered benefits, 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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