The Healthplex Indemnity/PPO (Preferred Provider Organization) Plan gives our members the flexibility to visit any dentist of their choice in or out of the Healthplex network.
In-Network PPO Plan
To receive the advantages of In-Network benefits, visit the Healthplex web site at www. healthplex.com to review the Directory of Preferred Providers who participate in the dental plan. The network of participating dentists will treat eligible active members and their eligible dependents with minimal or no out-of-pocket expense for covered services. When services are rendered from participating dentists in the Healthplex PPO Plan, you will only be responsible for the copayment, if any.
Out-of-Network Reimbursement Plan
Eligible active members and their eligible dependents may receive services from dentists who do not participate in the Healthplex PPO Plan. You are free to receive dental care from any licensed dentist not participating in Healthplex. When services are received from an out-of-network dentist, Healthplex will pay for all covered services according to the Out-of-Network Schedule of Allowances. For the most current Out-of-Network Schedule of Allowances, you can visit the SOC web site. You will be responsible to your dentist for all charges not covered or not paid in full by the plan.
The Healthplex Comprehensive Plan (Dentcare Delivery Systems) is a preventive dental program. Covered services can only be rendered by participating dentists. Members must select one participating dentist (per family) to provide general dental services. These primary dentists will provide all covered services according to the Schedule of Benefits/Copayments. Many preventive services are provided at no cost. Other services may require patients to make copayments directly to the dentist. For a copy of the Schedule of Benefits/Copayments, visit www.nypdsoc.com.
- General covered services can only be rendered by the member’s assigned dentist.
- Each member selects one participating dentist (per family) to provide general dentist services.
- Patients must receive referrals from their assigned dentist in order to have services covered for special procedures.
- Your Dentcare Identification Card will show your assigned participating dental provider.
- Provider changes can be made by completing and submitting a Dentcare Change Form.
The Healthplex/Dentcare Buy-Up Dental Plan is a member cost share plan. This enhanced dental plan has low monthly premiums paid through an authorized payroll deduction. Some of the highlights of the plan include:
- No co-payments for covered procedures when utilizing one of Healthplex's National Panel Network Providers.
- Allows you to visit any dentist in the expanded Healthplex National PPO Network.
- Utilizes the Healthplex National Network with over 500,000 access points.
- An annual maximum of $3000 per individual (January to December).
- Low co-pays for a standard In-Network 24-month Orthodontic case (restrictions apply).