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PEF Members:

PEF is taking action to address member dissatisfaction with the dental insurance provided by New York State.

For years there have been complaints about the dental benefit, not only by the PEF membership, but by the membership of other participating unions as well as management-confidential employees.

A major problem with the current dental insurance provided by EmblemHealth is the balance billing that results in significant out-of-pocket expenses for our members. Balance billing occurs when a member uses out-of-network providers or when they receive services not covered by the State plan. Unfortunately, too many PEF members have to use out-of-network providers because EmblemHealth’s current network is simply deficient. Compared to other dental carriers, they just don’t have as many dentists signed up as participating providers. In addition, EmblemHealth’s reimbursement rates in these situations are very low and this adds to the out-of-pocket expenses.

In order to assess our options to secure a dental benefit that better meets the needs of PEF members, including bringing the dental benefit “in-house” through a union benefit fund instead of through NYSHIP, PEF issued a Request for Proposals (RFP) to seven national dental carriers.  We are happy to report that we received enthusiastic responses to the RFP from six of the seven carriers.

PEF has been carefully analyzing the responses and continues to seek additional information from the carriers where needed.  We recently selected four finalists for continued follow-up, eliminating two of the carriers whose proposals were comparatively lacking.

In December and early January we had Zoom sessions with each finalist to allow for a more interactive exchange about our concerns, including with EmblemHealth. We let Emblem know in no uncertain terms how our members feel about the current coverage provided through the State. They were open to discussing how the network and benefit could be improved if we contracted with them directly.

At this point we are honing in with each carrier to get detailed information about their networks to assure that they can provide improved network access in the problem areas of the state and to determine if/where each carrier may need to recruit additional dentists to assure such access.

We also recognize that in some areas of New York, there are simply no dentists who participate with any carriers as participating providers. To that end, we are focusing on what guarantees each carrier would be able to provide to assure that our members would not be penalized for using out-of-network dentists if no in-network dentists are geographically available.

All of the remaining carriers are eager to continue the discussion about how to provide a benefit that best meets the needs of PEF members.

We will be sending out a dental survey in the next few weeks. Please take a moment to answer the survey as this will help us in the effort to obtain a dental benefit that better meets the needs of the membership

In Unity,

Wayne Spence, PEF President
Darlene Williams, PEF Contract Chair