Cover

Page numbers referenced within this brochure apply only to the printed brochure

EMBLEMHEALTH Dental

www.emblemhealth.com
1-877-842-3625

2024



IMPORTANT:
  • Rates
  • Changes for 2024
  • Summary of Benefits
A Regional Dental PPO Plan

Serving: All of New York and New Jersey counties of Bergen, Essex, Hudson, Middlesex,
Monmouth, Morris, Passaic, Somerset, Sussex and Union. Connecticut counties of Fairfield, Litchfield, New Haven.
Pennsylvania counties Pike and Monroe.

This plan has a High and a Standard enrollment option; please see the end of this brochure to determine your rates.

Options:

High Option - Self Only
High Option - Self Plus One
High Option - Self and Family

Standard Option - Self Only
Standard Option - Self Plus One
Standard Option - Self and Family

Federal Employees Health Benefits Program seal
OPM Logo