Dental Care Benefits
Dental Care
See Dental Care Summary Plan Description for more details.
Visit the RIT Service Center for questions about your benefits.
The Dental Care Plan covers many dental services; including preventative, restorative and orthodontia for children. The RIT Dental Care Plan is a self-funded plan administered by Excellus BlueCross BlueShield.
General Information
Regular full-time and part-time employees scheduled to work nine or more months are eligible to participate in the plan 12 months per year; regular full-time and part-time employees scheduled to work less than nine months are eligible to participate in the plan when working at RIT.
Employees may cover their spouse/domestic partner and children up to age 26. RIT pays the majority of the dental premiums for employees.
If you elect coverage as new hire, coverage begins on the first day of the month on or after your date of employment.
You need to enroll during your initial new hire enrollment period, during a mid-year qualifying event where you lost Dental Care coverage or during an annual Open Enrollment period. If you enroll during an Open Enrollment period, your coverage will be effective on January 1 of the upcoming year.
Search for a Local Dentist to find a participating provider.
The Claims Administrator for the RIT Dental Care plan is Excellus BlueCross BlueShield.
Customer Service: 800-724-1675/V and 585-454-2845/TTY
Dental Plan Benefits Comparison
| Category | Standard Plan | Enhanced Plan |
| Annual Deductible (applies to Basic and Major Restorative Services combined) | $25 per individual, $75 family maximum | None |
| Annual Maximum (applies to Basic and Major Restorative Services combined) | $1,250 per individual per year | $2,500 per individual per year |
| Orthodontia Maximum (per person) | $1,250 per lifetime for children under age 19 | $2,500 per lifetime for adults and children |
| Category | Standard Plan | Enhanced Plan |
| Cleaning (twice per calendar year) | Covered at 100% | Covered at 100% |
| Oral Exam (twice per calendar year) | Covered at 100% | Covered at 100% |
| Topical Fluoride application for members under age 16 (twice per calendar year) | Covered at 100% | Covered at 100% |
| Emergency Palliative Treatment to relieve pain | Covered at 100%, when no other services are rendered | Covered at 100%, when no other services are rendered |
| Sealants (once per tooth in 36 consecutive months for first and second unrestored permanent molars) | Covered at 100%, for members under age 16 | Covered at 100%, for members under age 16 |
| Space maintainers | Covered at 100% | Covered at 100% |
| X-rays (full mouth 1 in 3 years, bitewings 1 in 12 months) | Covered at 100% | Covered at 100% |
All services are subject to Blue Shield Schedule of Allowances and to the annual deductible and annual maximum.
| Category | Standard Plan | Enhanced Plan |
|
Endodontics (Nerve and Pulp) Root Canal Treatment |
Covered at 80% | Covered at 80% |
| Apicoectomy | Covered at 80% | Covered at 80% |
| Fillings – Silver/amalgam and anterior composite restorations for treatment of cavities (once per tooth per year) | Covered at 80% | Covered at 80% |
|
Oral Surgery Routine Extraction |
Covered at 80% | Covered at 80% |
| Non-routine Extraction (Surgical, Soft tissue, Impactions) | Covered at 80% | Covered at 80% |
| IV Sedation for extraction of impacted 3rd molars (wisdom teeth) | Covered at 80% | Covered at 80% |
|
Periodontics (Gum and Tissue) Surgical Procedures: gingivectomy, osseous surgery or mucogingival surgery (allowed once in 36 months) |
Covered at 80% | Covered at 80% |
| Non-Surgical Procedures: Periodontal Root Planning/Scaling (allowed once in 24 months) | Covered at 80% | Covered at 80% |
| Periodontal Maintenance following Surgery | Covered at 80%, allowed twice per calendar year | Covered at 80%, allowed twice per calendar year |
| Category | Standard Plan | Enhanced Plan |
| Dental Implants | Covered at 50% | Covered at 80% |
| Removable Prosthetics | Allowed once every 5 years, combined with fixed prosthetics | |
| Complete Dentures | Covered at 50% | Covered at 80% |
| Partial Dentures | Covered at 50% | Covered at 80% |
| Denture Repair/Adjustment | Covered at 50% | Covered at 80% |
| Fixed Prosthetics | Allowed once every 5 years, combined with removable prosthetics | |
| Crowns, Inlays/Onlays, Bridges | Covered at 50% | Covered at 80% |
| Category | Standard Plan | Enhanced Plan |
| Orthodontia Services | Covered at 50%, subject to the lifetime maximum (children under age 19) | Covered at 50%, subject to the lifetime maximum (adults and children) |
All covered procedures are subject to an alternative benefit allowance.
When there is more than one technique or material type for a dental procedure, the dental plan will reimburse for the procedure that has the lesser allowance. When alternate benefit is enforced, the subscriber’s benefits are not intended to interfere with the treatment plan recommended by the dentist. The subscriber and dentist should discuss which treatment is best suited for the patient, and may proceed with the original treatment plan regardless of the benefit determination. If the more expensive treatment is chosen, the subscriber is liable for the balance up to the billed amount.
A Predetermination of Benefits is a written estimate from the insurance company of the amount your dental plan will pay for a specific service based on the treatment plan provided by your dentist. Predetermination of benefits should be requested when using the Basic Restorative, Major Restorative or Orthodontia benefits,
The Dental Plans allow you to see any dentist you choose. However, nonparticipating dentists are not obligated to accept Excellus BCBS’s allowed amounts as payment in full and will balance bill any amount in excess of these allowed amounts.
Priced according to the Blue Shield Schedule of Allowances. Dentists who participate with Blue Shield agree to accept the Schedule of Allowances. Subscribers who go to a non-participating dentist will be liable for balances over the Schedule of Allowances.
NOTE: All rules, limits, and exclusions apply regardless of plan (e.g., you would still have a 5-year wait to replace a crown even if you change plans).