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Retiree Dental Plans

Maintaining good oral health is vital to your overall health and wellness. Our two dental plans, the Traditional Plan and Medallion Plan, are both administered by Excellus BlueCross BlueShield and offer you coverage for your dental needs. Take a look at the plan features below.

Printer-friendly 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*

  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/onlays/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.

Retiree Dental Plan Rates

University Dental Plan Monthly Quarterly
Single Family Single Family
Traditional Dental Plan $32.64 $62.82 $97.92 $188.46
Medallion Dental Plan $42.50 $81.80 $127.50 $245.40

Retirees are billed quarterly for their share of the premium

These rates are applicable for 4R and 5R Retiree levels.

Note: At this time, dental benefits are not available to SEIU retirees or surviving spouses.

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.

Dental Billing

Dental premiums are billed through Lifetime Benefit Solutions (LBS). Invoices will be mailed quarterly from LBS. See an invoice example.

You will have 30 days to pay the invoice. You have a couple of options to pay your bill:

  • Pay by Automatic Recurring Debit: You can authorize LBS to automatically debit your account on a quarterly basis for your dental premiums. There is no need to remember to send a check each quarter, though you can still pay by check if you want to.
  • Pay by Credit Card: You will have two options to pay by credit card. You can pay via the online member portal (convenience fee does apply) or pay by credit card over the phone with the customer service team (no fee applies).

View your account at any time by setting up your online account today with LBS. You can view the status of your account on the LBS member portal or mobile app. Both systems allow you to make payments, view your payment history, verify enrollment, access all previous bills and correspondence, and set up automatic debit.

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