Having healthy teeth is part of staying healthy.
Our goal at EmblemHealth is to provide you with access to high-quality dental care, which is why we have contracted with Healthplex to manage the dental needs of our HIP FHPlus members. Healthplex gives you access to their large network of quality dentists, which includes a dental clinic operated by an academic dental center. FHPlus members will receive the following services:
- Routine exams
- X-rays
- Cleanings, fillings and tooth pulling
- Emergency treatment
- Replacement of missing teeth (full and partial dentures). Covered when conditions meet Medicaid guidelines.
- Root canals. Patients must be evaluated on a case-by-case basis to determine if conditions meet Medicaid coverage guidelines. Coverage will generally be provided when the number of teeth needing or likely to need root canals is "not excessive" and the patient has good oral hygiene, and has a healthy mouth and gums, and:
- Has few, if any cavities; and
- Has a full complement of natural teeth; and
- Has had all other necessary restorations completed; and/or
- Is undergoing orthodontic treatment
Root canals will not be covered when the prognosis of the tooth is questionable or extraction and replacement is a reasonable alternative course of treatment. Molar root canals will not be covered for patients over the age of 21, except where the tooth is a critical abutment for an existing prosthesis.
- Crowns will not routinely be approved if restorative materials can restore the teeth. Crowns will not be covered on molar teeth for patients over the age of 21.
- Fixed bridges are considered beyond the scope of the program and are not covered.
When you need covered dental specialty services, your Healthplex network dentist will refer you.
Orthodontic services are not covered.
If you have questions about your dental coverage or would like to change your
HIP network dentist,
please call Healthplex at 1-800-468-9868, Monday through Thursday from 8 am to 8 pm, and Friday
from 8 am to 6 pm.