BlueShield of Northeastern New York |
Blue Value Dental 1, NS, OON, Blue Marketplace, Dep25 Adult/Family Dental |
N |
|
Individual |
Age 25 |
N |
|
|
|
|
Y |
Albany |
|
|
$50 |
None |
$50 per member up to $150 per family |
None |
$0 |
$0 |
$0 |
$0 |
Not covered |
$0 |
Not covered |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
Not covered |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
Not covered |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
Not covered |
Not covered |
$0 |
$350 |
$0 |
$700 per group |
$20 copayment |
50% coinsurance |
50% coinsurance |
50% coinsurance |
$50 |
None |
$50 per member up to $150 per family |
None |
$0 |
$0 |
$0 |
$0 |
Not covered |
$0 |
Not covered |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
Not covered |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
Not covered |
Not covered |
$0 |
$350 |
$0 |
$700 per group |
$20 copayment |
50% coinsurance |
50% coinsurance |
50% coinsurance |
N |
N/A |
Y |
Pays in-network participating provider allowed amount |
N |
Blue Marketplace |
|
BlueShield of Northeastern New York |
Blue Value Dental 1, NS, OON, Blue Marketplace, Dep29, Adult/Family Dental |
N |
|
Individual |
Age 29 |
N |
|
|
|
|
Y |
Albany |
|
|
$50 |
None |
$50 per member up to $150 per family |
None |
$0 |
$0 |
$0 |
$0 |
Not covered |
$0 |
Not covered |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
Not covered |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
Not covered |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
Not covered |
Not covered |
$0 |
$350 |
$0 |
$700 per group |
$20 copayment |
50% coinsurance |
50% coinsurance |
50% coinsurance |
$50 |
None |
$50 per member up to $150 per family |
None |
$0 |
$0 |
$0 |
$0 |
Not covered |
$0 |
Not covered |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
Not covered |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
Not covered |
Not covered |
$0 |
$350 |
$0 |
$700 per group |
$20 copayment |
50% coinsurance |
50% coinsurance |
50% coinsurance |
N |
N/A |
Y |
Pays in-network participating provider allowed amount |
N |
Blue Marketplace |
|
Delta Dental of New York, Inc |
Delta Dental PPO Basic Plan for Families NS OON Family Dental Dep 25 WP |
N |
|
Individual |
Age 25 |
N |
|
|
|
|
Y |
Albany |
|
|
$50 |
None |
$150 per group |
None |
Not covered |
$0 after deductible |
$0 after deductible |
$0 after deductible |
Not covered |
$0 after deductible |
Not covered |
Not covered |
50% after deductible |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
50% after deductible |
$65 |
$350 |
$195 per group |
$700 per group |
$0 after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
$50 |
None |
$150 per group |
None |
Not covered |
$0 after deductible |
$0 after deductible |
$0 after deductible |
Not covered |
$0 after deductible |
$0 |
$0 |
50% after deductible |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
50% after deductible |
$65 |
$350 |
$195 per group |
$700 per group |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
N |
N/A |
Y |
National network |
Y |
Delta Dental PPO |
|
Empire BlueCross (Dental Upstate) |
Empire Dental Family Enhanced, NS, OON, Prime, Dep25, Adult/Family Dental, WP |
N |
|
Individual |
Age 25 |
N |
|
|
|
|
N |
Albany |
|
|
$50 |
None |
$50 per member up to $150 per family |
None |
Not covered |
0% after deductible |
0% after deductible |
0% after deductible |
Not covered |
0% after deductible |
Not covered |
20% after deductible |
20% after deductible |
50% after deductible |
Not covered |
50% after deductible |
50% after deductible |
50% after deductible |
50% after deductible |
50% after deductible |
50% after deductible |
Not covered |
50% after deductible |
50% after deductible |
50% after deductible |
50% after deductible |
Not covered |
Not covered |
$0 |
$350 |
$0 |
$700 |
$0 |
20% coinsurance |
50% coinsurance |
20% coinsurance |
$50 |
None |
$50 per member up to $150 per family |
None |
Not covered |
50% after deductible |
50% after deductible |
50% after deductible |
Not covered |
50% after deductible |
Not covered |
50% after deductible |
50% after deductible |
50% after deductible |
Not covered |
50% after deductible |
50% after deductible |
50% after deductible |
50% after deductible |
50% after deductible |
50% after deductible |
Not covered |
50% after deductible |
50% after deductible |
50% after deductible |
50% after deductible |
Not covered |
Not covered |
$0 |
None |
$0 |
None |
$0 |
20% coinsurance |
50% coinsurance after deductible |
20% coinsurance |
Y |
Out of Country covered services are reimbursed as out-of-network benefits. |
Y |
If a member does not use a network dentist, services will be reimbursed at the out-of-network level. |
N |
Dental Prime |
|
Empire BlueCross (Dental Upstate) |
Empire Dental Family Value, NS, OON, Prime, Dep25, Adult/Family Dental, WP |
N |
|
Individual |
Age 25 |
N |
|
|
|
|
Y |
Albany |
|
|
$50 |
None |
$50 per member up to $150 per family |
None |
Not covered |
0% after deductible |
0% after deductible |
0% after deductible |
Not covered |
0% after deductible |
Not covered |
50% after deductible |
50% after deductible |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
$25 |
$350 |
$25 per person |
$700 |
25% coinsurance after deductible |
25% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
$50 |
None |
$50 per member up to $150 per family |
None |
Not covered |
50% after deductible |
50% after deductible |
50% after deductible |
Not covered |
50% after deductible |
Not covered |
50% after deductible |
50% after deductible |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
$25 |
None |
$25 per person |
None |
25% coinsurance after deductible |
25% coinsurance after deductible |
50% coinsurance after deductible |
50% coinsurance after deductible |
Y |
Out of Country covered services are reimbursed as out-of-network benefits. |
Y |
If a member does not use a network dentist, services will be reimbursed at the out-of-network level. |
N |
Dental Prime |
|