Dental insurance forms
Access and complete forms relevant to your dental care plan, including forms to file a claim.
Dental Plans
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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
| 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*
|
Plan pays 100% of in-network negotiated rates, no deductible |
|
Class II and IIA—Basic Restorative Services*
|
Covered at 80%, subject to deductible |
|
Class III—Major Restorative Services*2
|
Covered at 15%, subject to deductible |
Covered at 50%, subject to deductible |
Class IV—Orthodontia*
|
Not Covered |
**Covered at 50%, subject to orthodontia lifetime maximum |
- Covered twice per calendar year
- Services are reviewed for medical necessity.
- 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.
Frequently asked questions
Answers to your dental plan questions
Get in-depth information on dental insurance coverage.
Additional support
Dental care discounts
At the Eastman Institute for Oral Health, University of Rochester employees can receive a 10% discount on some dental services not covered by insurance.
Find your dentist
Use the “Find a Dentist” tool to search for dentists in the Excellus network, choosing “Dental Blue Options” when it asks you to select your plan.
2023 ALEX tool
An interactive online benefits decision tool that will assist you in understanding your benefit options and enable you to make an informed decision when making your benefit elections.