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Our two dental plans, the Traditional Plan and Medallion Plan, are administered by 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鈥檚 allowed amounts as payment in full and will balance bill any amount in excess of Excellus BCBS鈥檚 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鈥檚 payment and the amount billed by the Dentist.
Class I鈥擯reventive Services*

  1. Cleanings and oral exams1
  2. Fluoride treatments covered to age 16
  3. Sealants covered to age 16
  4. Bitewing x-rays2
  5. Full mouth and panorex x-rays
  

 

Plan pays 100% of in-network negotiated rates, no deductible
Class II and IIA鈥擝asic 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鈥擬ajor Restorative Services*3

  1. Fixed removable prosthetics
  2. Implants (limited coverage requires preauthorization)4
  3. Inlays / onlay / crowns
  

 

Covered at 15%, subject to deductible

  

 

Covered at 50%, subject to deductible
Class IV鈥擮rthodontia*

  1. Class IV鈥擟oinsurance
  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. Up to four (4) bitewing films covered per calendar year
  3. Services are reviewed for medical necessity
  4. 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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