Dental Insurance Benefits

Almost half of your patients are likely to have a dental benefit plan. It may be provided by their employer, a government plan or a plan they purchased individually. Some plans are “insurance,” i.e., policies purchased from a company that assumes financial risk. Insurance plans are regulated by the New York State Department of Financial Services’ Insurance Bureau. In most cases, dental plans are directing plan purchasers to participating provider networks. Dentists in these networks agree to discount their fees to patients enrolled in the benefit plan.

Other dental plans are “self-funded”, i.e., a company or union, for example, reimburses its employees/members for claims directly or through a third-party administrator (TPA). Self-funded plans are subject to ERISA (the Employment Retirement Income Security Act of 1974) and is federal law. These types of plans are not generally subject to state insurance laws and do not fall under the purview of any state insurance commissioner or department. They are regulated by the U.S. Department of Labor.

Patients also may purchase discount plans that allow them to receive discounts from participating dentists but do not provide any reimbursement for treatment services.

NYSDA can help to resolve problems you may be having with your patients’ dental benefit plans:  Third-Party Payer Complaint Form


ADA Publication:  Responding to Claim Rejections
ADA Dental Insurance Resources

Changes to NYS Workers’ Compensation Dental Claim Submissions

(Published June 2, 2021)

Do you treat patients who are injured in a workplace accident? If so, you should be aware that the NYS Workers’ Compensation Board is in the process of developing a new claims system called OnBoard. OnBoard is a web-based platform that will enable providers to submit dental and medical claims and prior authorization requests electronically. Providers will have access to real-time claims data and will be able to track claims status.

The first phase of the upgrade will be implemented in the summer of 2021. OnBoard: Limited Release for dentists will include the submission of prior authorization requests (PAR). Providers will be able to view their PAR submissions on a dashboard with 24/7 access, receive PAR status updates via email and communicate directly with insurers concerning a PAR.

The second and third phases of OnBoard are scheduled for release some time in 2022 and 2023, respectively. Dental claim submissions will be included at that time. Providers should begin preparing now to be ready this summer for the transition to electronic PAR and dental claim submissions.

To get started:

  1. Register for access to the Board’s Medical Portal.
  2. Select “Access and Administration” under Health Care Providers.
  3. Select “Sign Up for Access to the Medical Portal.”

It may take up to five business days for the Board to review your registration. Once your registration is approved, you will receive an email containing an ID number and temporary password to access the Medical Portal.

Workers’ Compensation Law does not require dental providers to be authorized by the Board, as physicians are. Registering for access to the Medical Portal to submit PARs and claims does not mean that you are “enrolled” in Workers’ Compensation or are required to treat every patient seeking treatment as a result of a workplace accident.

To receive updates, dentists should register for OnBoard emails. The Board is hosting webinars, which provide training and updates on the upcoming OnBoard: Limited Release system, in addition to factsheets, website content, and instruction guides and tutorial videos to demonstrate use of the new system.

Additional Information

Questions about the registration process:  Contact Customer Service at the Workers’ Compensation Board, 877-632-4966.

Questions about OnBoard:  Email:

Additional questions may be directed to Jacquie Donnelly at NYSDA,

Dental Insurance Programs

  • Workers' Compensation/No-Fault Insurance
  • Medicaid
  • Medicare