The Superior Officers Council currently sponsors three dental plans for our retired members. The Healthplex Indemnity/PPO Plan, the Healthplex Comprehensive Plan (Dentcare Delivery System) and the Compbenefits Plan, administered by Humana (Florida residents only).
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 Dentists who participate in the dental plan. The network of participating dentists will treat eligible retired 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 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-ofnetwork 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. Most services 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 to the SOC Fund Office the Dentcare Change Form.
Healthplex/Dentcare Buy-Up Dental Plan (Members will have the option to enroll during open enrollment periods. Open enrollment periods are announced periodically). 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).
Compbenefits By Humana (Florida Residents Only)
CompBenefits is a network based plan that emphasizes prevention and cost containment. In order to receive services, you must select a primary dentist who participates in the CompBenefits network.
- Provides fixed copayments from primary and in-network specialty dentist
- Provides a 25% discount from your primary care dentist for procedures not covered under the plan
- There are no claim forms to be filled; copayments are billed at the time of service
- The plan does not cover service (except emergency care) received from out-of-network dentists
- There is no reimbursement schedule allowance. Participating providers are paid copayments directly, by you the member