The fee-for-service plan allows you to go to any dentist of your choice. You or your dentist must then submit a claim form to Blue Cross for reimbursement. The Plan will pay according to its established fee schedule. The difference between the amount the provider bills and the amount the Plan pays is your responsibility.
You can download a Dental Plan claim form. Note: It is very important that you complete the correct form for the Plan you are in, as failure to do so will delay the processing of your claim and reimbursement, if applicable.
The Blue Cross Dental Managed Network Program, which is an HMO, requires you to enroll in the program and remain enrolled for a minimum of one year. Once you are enrolled, you may choose your dentist from a panel of participating dentists and then must use only that dentist for you and your family, if applicable. Covered services will be paid in full, and you will not have any out-of-pocket expense. If you use a dentist outside of the program, you will not be covered for those services.
To enroll in the Blue Cross Dental Managed Network Program, contact the Members’ Records Department at (718) 591-2000, Extension 2491.
The DDS, Inc. program allows you to enroll at any time during the year by calling DDS, Inc. at (800) 255-5681. The DDS, Inc. network is a closed panel of participating dentists who agree to accept the Plan’s allowances for covered services as payment in full. Once you have selected your DDS provider, you may make an appointment. No claim forms are required.
Participants in the Empire Blue Cross and Blue Shield Fee-For-Service Program (the “Fee-for-service Program”): You and your dentist will need to complete a Dental Claim Form for all services received. You may obtain a Dental Claim Form online or by contacting the Members’ Records Department. You complete the patient’s portion of the Dental Claim Form and your dentist completes the remainder of the form. Then return the completed form to Empire Blue Cross and Blue Shield Dental Benefits Program, P.O. Box 810, Minneapolis, MN 55440-0810.
Participants in the Empire Blue Cross and Blue Shield Dental Managed Network Program (the “Managed Network Program”): Once you enroll and select a dental office, you will not need to submit any forms or obtain pre-certification for any services. Your dental office will take care of any required paperwork.
Participants in the DDS, Inc. Program: You will not need to submit any forms or obtain pre-certification for any services. The DDS dental office is responsible for any required paperwork.
You are required to submit a Dental Claim Form within one year of receiving dental services. Although not required, you are encouraged to contact Blue Cross Blue Shield in advance of receiving dental services to verify that coverage is available, especially in the case of prosthetic and orthodontic services.
The maximum amount payable is $4,000.00 per lifetime per person.
The maximum amount payable is $4,000.00 per person per calendar year.
Both Dental Plans cover two cleanings per year (once every 6 months).
For all participants in the Dental Benefit Plan of the Elevator Industry, non-cosmetic dental implants will be covered for charges up to $900. Associated charges for abutments and bone grafts will also be covered as per the Plan's fee schedule. This benefit is part of the $4,000 annual prosthetic maximum and is part of the fee-for-service program only. Participants in the DDS preferred provider organization and the Empire Dental Managed Network Program are subject to the fee-for-service plan allowances for this benefit only. Since implant related services are reimbursed according to the Plan's fee schedule, it is strongly recommended that your dentist submit a pre-estimate request on your behalf to either Blue Cross or DDS, Inc. This will help estimate your out-of-pocket costs.
