Anyone with questions about the work they are currently receiving or want to have can submit a pre-determination form with the Aetna Claims office.
However, no one who started the work under the Emblem plan should have an interruption in coverage with the transition to Aetna. The provider will submit the work that is performed after the Aetna effective date to Aetna for claims payment.
If a member has already met the deductible and wants to receive credit for it, they should contact Dental Member Services and submit an EOB proving they have met the deductible. This will allow for a credit. It will however also reduce the calendar year maximum by whatever amount they have used thus far. Therefore, if someone has already hit the Calendar Year Max (CYM) or is close to it but needs a lot more work done, I would not recommend they ask for a deductible credit. If the person in this situation simply pays the deductible again, they will also have the full CYM to utilize through 12/31.
As a reminder, Dental Member Services can be reached at 877.238.6200.
In order to provide our membership with consistent or improved level of dental than we currently have, this letter is advising you that we will be switching Dental Insurance providers from Emblem Health / GHI to Aetna effective August 1st, 2016.
Your dental plan will automatically be switched over from the plan that you are currently enrolled in. You as the member do not have to do anything except download and print your new dental card to present to your dental office. (the website and instructions will be sent to your home address in a letter from Aetna).
- If you are in a single plan, you will be switched to a single plan.
- If you are in a family plan, you will be switched to a family plan.
- If you are in the plan that does not include orthodontia, you will be switched to the plan that does not include orthodontia
- If you are in the plan that includes orthodontia, you will be switched to the plan that does include orthodontia.
If you wish to make any changes to the plan that you are currently enrolled in Open Enrollment is from November 1st – November 30th. (Ex. If you no longer need orthodontia, or if you will need orthodontia.)
However, if you have an address change, or have had a qualifying event, please submit these changes ASAP to Maria Doverspike, 721 City Hall, Buffalo, NY 14202. If you have any questions you can reach Maria at 716.816.3932.