Emblem Dental Plan

For a complete summary of your plan, click here.IB Image

Emblem dental benefits will not be available in your Business Service Center, (BSC Portal)

For information about your TWU Local 100 Premier Dental Benefits and how to enroll, follow the instructions below:

Visit – Emblem Health TWU Local 100 Premier Dental Plan

  • Register to create your own Emblem Health Account and experience the newly designed dental portal board with transparent details about your dental plan.
  • If you did not receive a dental card with the Member ID essential to the registration process, Contact Customer Service at: (866) 234-8697 TTY: 711 and they will guide you or provide you with the ID# so that you may complete the registration process.

Once you have successfully completed your registration, you will be able to utilize numerous links to obtain additional information such as:

  • “Find a Doctor” in your network at the top of the page of your account.
  • You can find a Dental Enrollment Form at this link.
  • You can find a Member/Dependent change form at this link.

* STUDENT COLLEGE CERTIFICATION IS NOT REQUIRED UNDER OUR DENTAL PLAN GUIDELINES 

*Annual Enrollment Change Period is October 15 – November 15”
 
  PPO Plan
BENEFITS In and Out-of-Network benefits
PROVIDERS In and Out-of-Network
GENERAL DENTISTS 13,553 in the NY/NJ Area; 415,000+ Nationwide
CO-PAYMENTS None for covered services In-Network
ANNUAL MAXIMUM BENEFIT $2,000 per person
$4,000 per family
(only applies to member and dependents who are 19 or older)
DEDUCTIBLE NONE
CLAIM FORMS Yes - claims forms needed for Out of Network only
REFERRALS No
NON-PARTICIPATING REIMBURSEMENT Yes - based on Spectrum fee schedule
ORTHODONTIA Orthodontia covered to age 26 as long as patient has been fully banded prior to age 23
IMPLANTS One implant covered per member and one for each dependent per year
 

Important Forms (Downloadable)
*Adding or removing dependents may require verification documents such as: (ie.Birth Certificate, Marriage Certificate).

You have the right to enroll in COBRA.

  • Download and complete the COBRA Form
  • Attach verification of your official retirement date, NYCERS Form: F541 or a Time Allowance Record may be used.

All forms and required dependent verification documents must be included to add/remove dependents. Once completed, you have four different ways you can submit the forms:
1. Submit in-person during orientation.
2. Submit in-person at: 149 Pierrepont St. between Cadman Plaza and Clinton St. 1st Flr.
3. Email forms to: member.services@twulocal100.org
4. Fax to: (347) 916-0629

Certificate of Insurance