April 3, 2024 — It took years of hard work and tenacity on the part of PEF leaders and members, but New York State will replace EmblemHealth with Anthem Blue Cross as the dental provider in the New York State Health Insurance Plan this fall.
This is the culmination of years of effort. PEF led the way in pushing for a better dental plan for state workers, which will now benefit other bargaining units such as those represented by Council 82, OMCE, NYSCOPBA, and the State Police. PEF members made their feelings clear to their elected leaders, complaining that EmblemHealth was deficient and inadequate to meet their needs. Too few dentists accepted the plan, and the reimbursement rates for members who received out of network dental care were paltry.
“We saw all these dentists walking away from the Emblem network because they claim they are losing money and they can’t afford to treat our members,” said PEF President Wayne Spence. “When I became President in 2015, I started pushing for changes to the plan.”
PEF members have been most critical of the plan in parts of upstate New York where there are not enough dentists who accept EmblemHealth, forcing members to pay high out-of-pocket costs. The union put out its own Request for Proposals (RFP) in 2020 and learned that there are other dental carriers with better networks and less expensive administrative fees than what the State currently pays EmblemHealth.
“Our view is that Emblem was really nothing but a coupon for our members,” said PEF President Spence, “not nearly good enough to provide PEF members with the comprehensive dental care they deserve.”
EmblemHealth’s balance billing resulted in significant out-of-pocket expenses for members as the number of in-network providers dropped. Balance billing occurs when a member uses out-of-network providers or when they receive services not covered by the plan. Dentists advised that they dropped the plan, in part, because EmblemHealth’s reimbursement rates are very low.
History of PEF advocacy
More than 15 years ago, PEF secured a side letter in the 2007-2011 PS&T contract to fund a comprehensive analysis of the State’s Dental and Vision benefits. That study resulted in a recommendation of alternate means to provide benefits that might have offered enrollees enhanced benefits while potentially decreasing the overall cost to the State.
When the State did not accept that proposal, PEF did what unions do best — continued to fight. During the COVID pandemic in 2020, PEF put out its own Request for Proposals (RFP) for new dental carriers in order to get a better sense of the benefits landscape and what might be possible. That process educated the negotiating team about typical fees and what other vendors offered.
During negotiations for the 2019-2023 PEF contract, PEF secured some upgrades to the dental plan – including an increase in the maximum annual benefit per covered person from $2,300 to $3,000. Most importantly, the union convinced the State to put out its own RFP for a new dental carrier – something they had not done in more than 20 years. But when President Spence learned during the 2023-2026 contract talks that the State had not yet done so, the PEF Contract Team took it up a notch. PEF’s current contract includes a $400-per-year annual stipend until the State enters into a new dental services contract. The $400 is payable in each fiscal year in which a new dental services contract is not in place for any portion of that fiscal year. The 2023 stipend was paid in March 2024, costing the state more than $24 million (approximately 51,000 PEF members times $400, plus administrative costs). PEF knew with dollar amounts like that the State would have a major incentive to fix the problem.
The State secured responses to their RFP for a new dental carrier and PEF was involved in evaluating the proposals.
“Union representatives were part of the interview committee,” said PEF Contract Administration Director Debra Greenberg. “We reviewed the RFP responses provided to us by the State.”
The State approved Anthem Blue Cross to administer the NYSHIP dental program in late March 2024. The new plan is expected to take effect in September or October 2024, following a 180-day implementation period. The exact date and all revised plan materials will be provided by the State as the date approaches.