Update: As previously announced, on Oct. 15, 2024, we welcomed a new large group of employees to our dental plans, members of TWU Local 100, New York’s public transit union. These members can visit any dentist in the EmblemHealth Preferred Premier Dental network.
We have an update to share with you for clarification:
EmblemHealth covers implant services for one tooth per 12-month period.
Implant coverage and directly related services during the implant procedure (e.g. abutments, crowns, bone grafts, etc.) that are performed by a participating provider are not subject to the plan annual dollar maximum. Claims filed for services performed by in-network providers will be paid in full at the contracted in-network rates.
For out-of-network services, members will be reimbursed at the nonpar reimbursement schedule and will be subject to balance billing from the provider. A separate annual maximum of $1,000 per 12-month period applies to out-of-network implant services.
If you have questions, please use the provider portal Message Center at emblemhealth.com/providerportal.
Thank you for the care you provide to our members.
JP 67726 11/2024