June 26, 2024 — Members made it clear – the EmblemHealth dental plan lacked a robust provider network, costing members too much in out-of-pocket expenses and making it difficult, or sometimes impossible, to find network dentists within a reasonable distance from their home.
PEF led a multi-year, multi-union campaign advocating for the state to change its dental insurer and as a result, the state put the NYSHIP dental contract out to bid for the first time in more than two decades, recently awarding the contract to Anthem Blue Cross (Anthem), effective Oct. 1, 2024. With Anthem’s more robust network, many more members will be able to access network dentists.
The process of making the switch can be confusing.
“We want to dispel some misinformation at this point in the implementation process,” said PEF President Wayne Spence. “We have heard concerns that with Anthem there will be a lower level of benefit or co-pays where none previously existed. This is absolutely not true. Anthem has many different dental plans. The new NYSHIP dental plan is a unique Anthem plan and details have not yet been published on the Anthem website.”
With the transition to a new provider, there have been questions regarding current “treatment in progress” services, such as orthodontia. PEF has requested information from the state on the specifics related to such continuity of care and will pass on that information once it is received.
The level of benefit is governed by the collective bargaining agreement, including enhancements achieved during the negotiation of the 2019-2023 PEF/State Agreement, such as a higher annual maximum allowance of $3,000 per person, an increase to $3,000 for the orthodontic lifetime maximum per child, inclusion of a $600 implant allowance, and long overdue coverage for precious/upgraded metal fillings.
“These previously negotiated enhanced contractual benefits will continue and will certainly not be diminished,” said Spence. “As always, we will seek to build on these improvements in the next round of contract negotiations. Most importantly, with Anthem, our members will have access to a more robust dental network.”
The Department of Civil Service plans to send out the following mailings to NYSHIP dental plan enrollees:
- NYS Dental Plan Administrator Change Letter
In July, the Department of Civil Service will mail this letter to enrollees’ homes. This letter will explain the change to Anthem and will highlight how enrollees can access and search the applicable Anthem Blue Cross network of dental providers. - Anthem Blue Cross NYS Dental Plan Benefit Documents and Benefit Card
In September, enrollees will receive a welcome letter from Anthem Blue Cross, which will include their new benefit card along with information on how to access benefit information and documents online through a secure member portal.
Dental providers interested in joining the Anthem NYSHIP network can call 1-866-947-9398 to speak to a designated Anthem representative. Members are encouraged to share this number with their dental provider so they can join the applicable Anthem network if they are not already an Anthem participating provider.
“We will vigorously monitor the changeover to Anthem to make sure it meets all our expectations,” Spence said. “If for some reason it does not, we will take immediate action to assure all necessary corrections are made.”