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Information about your benefits under the NYS Dental Plan administered by EmblemHealth, and the NYS Vision Plan administered by Davis Vision. As of October 1, 2024, Anthem will be the plan administrator for the New York State Dental Plan. Your benefits are not changing; please refer to the Emblem Certificate, Attachment, Rider, and other benefit documents until Anthem branded documents are available this fall. Click here to learn more about the change.
For more information regarding the October 1 changes to the NYS Dental Plan, please review these Frequently Asked Questions.
NYS Dental Plan Certificate of Insurance
Updated as of June 9, 2023
Attachment to NYS Dental Plan Certificate of Insurance
For PEF, effective January 1, 2022
Rider to NYS Dental Plan Certificate of Insurance and Attachment
Updated as of February 12, 2024
Dental and Vision Brochure
Effective January 1, 2022
PEF Vision Plan Book
Updated as of January 1, 2024
If you have diabetes or another medical condition that has changed your vision, it is important to receive an annual eye exam. The Medical Exception Program allows you to receive an eye exam every year, instead of every two years, with a qualifying medical condition. Other qualifying medical conditions include but are not limited to cataracts, keratoconus, cataract surgery within two years of last prescription, and taking prescription drugs that would cause vision changes. Additionally, you are eligible for new lenses or contacts if you experience a significant vision loss due to a qualifying medical condition. A significant prescription change is defined as a minimum change of .75D sphere and/or 1.00D cylinder or more since your last eye examination.
For more information on vision benefits and the Medical Exception Program, contact Davis Vision at 1-888-588-4823 or refer to www.DavisVision.com.
Administrator Change to Anthem Blue Cross, effective 10/1/2024
To find out if your current provider participates in the Anthem network, visit https://www.anthembluecross.com/nys-dental.
If you are a NYS Dental Plan enrollee, select "New York State Dental Plan" under Search for a Dental Provider. You will be directed to the XPO Dental Complete network where you can search for providers by address, doctor name or specialty type.
If you are a NYS Dental Student Employee Health Plan (SEHP) enrollee, select "New York State Dental Plan Student Employee Health Plan (SEHP)" under Search for a Dental Provider. You will be directed to the XPO Dental Complete network where you can search for providers by address, doctor name or specialty type. You can filter network results or select the link for "Dental Discount Program Providers" to view providers who may charge you less than their normal fee for services not reimbursed by the NYS Dental SEHP.
There are some situations where a provider may not be listed, so you can also call the dedicated Anthem NYS Dental Plan toll-free number, 1-833-821-1949 to check participating status.
You can complete the NYS Dental Plan Provider Nomination Form available on https://www.anthembluecross.com/nys-dental. The completed form can be submitted to the email address listed on the form.
There will be no impact or changes to your dental benefits as a result of this transition. The benefits outlined in your current New York State (NYS) Dental Plan Certificate of Insurance, Attachment to the NYS Dental Plan Certificate of Insurance and Rider to the NYS Dental Plan Certificate of Insurance and Attachment will not change. Updated Anthem branded documents will be available this fall. To view your current dental benefit documents, visit the New York State Insurance Plan website at www.cs.ny.gov/employee-benefits. Select New York State Active Employee (NY), your group, Dental and/or Vision and Dental Benefits.
In September, you will receive a welcome letter from Anthem Blue Cross and a new plan benefit ID card with the Anthem Blue Cross corporate logo. Please note, this will be delivered in a safe unmarked envelope to your home address. Beginning October 1, you must use this Anthem ID card when obtaining dental services.
If a pre-determination request was submitted to Emblem prior to 10/1/24 and services were approved, Anthem will continue to approve those services 10/1/24 and after. Members' cost share could change effective 10/1/24 depending on whether the provider is in-network or out-of-network with Anthem, so members should confirm the participating status of their doctor on https://www.anthembluecross.com/nys-dental or call the dedicated Anthem NYS Dental Plan toll-free number at 1-833-821-1949 with any questions. All services rendered on 10/1/24 and after should be submitted to Anthem either electronically by a participating provider or by mail to: Anthem Dental Claims PO Box 1482 Minneapolis, MN 55440-1482.
Anthem is actively recruiting as many providers into their network as possible. To find out if your current provider participates in the Anthem network, visit https://www.anthembluecross.com/nys-dental, select Search for a Dental Provider and select Find a Dental Provider. You will be directed to the XPO Dental Complete network where you can search for providers by address, doctor name or specialty type. There are some situations where a provider may not be listed, so you can also call the dedicated Anthem NYS Dental Plan toll-free number, 1-833-821-1949 to check participating status.
Yes, orthodontia claims with a date of service prior to 10/1/24 will be paid by Emblem. Orthodontia claims with a date of service of 10/1/24 or after will be paid by Anthem. Orthodontia benefits will continue to be paid out monthly.
Yes. An informational video presentation is now available. The approximately 5-minute resource is posted on Anthem's NYS Dental Plan customized website at https://www.anthembluecross.com/nys-dental and on NYSHIP Online under What's New.
Yes. Effective Friday, August 16, 2024, you can securely log-in to the NYS Dental Plan website at https://www.anthembluecross.com/nys-dental. If you currently have active Empire Plan coverage and have previously setup an account with Anthem to view your Hospital Program benefits, you can use your existing username and password. You will be able to view your Hospital Program benefits and your Dental Plan benefits through the same web portal. If you are a new user, you can call the dedicated Anthem NYS Dental Plan toll-free number at 1-833- 821-1949 to obtain your Anthem ID number which is needed to register for an account. Once registered, you will then be able to view your dental benefits and eligibility information.
Anthem also has a Sydney Health mobile app that you can download to your phone or tablet. More information is available at https://www.anthembluecross.com/nys-dental.
Yes, as of October 1, 2024, Anthem will offer Direct Pay policies for eligible members. Individuals can enroll at any time on or after October 1, 2024, and coverage will be effective on the first of the month following the date they apply. To find out more about available options, you can visit https://www.anthem.com/ny/individual-and-family/dental-insurance.
The dedicated Anthem NYS Dental Plan toll-free number is 1-833-821-1949.
Contact your agency Health Benefits Administrator for information about continuing coverage under COBRA.
