The dental plan administered by United Concordia provides for payment on the basis of a fee schedule which determines an allowance based on a usual and customary fee.
What is a participating dentist?
- A participating dentist is a dentist who has signed a contract with United Concordia.
- The participating dentist must accept the total allowed charge (prevailing fee) as his or her fee. United Concordia will pay the dentist 100%, 80% or 50% of the permitted total, depending upon the services. The member pays either: nothing, or 20% of the prevailing fee, or 50% of the prevailing fee, depending on the services. If the charge of a participating dentist exceeds the charge permitted by United Concordia, please call the Health and Welfare Fund office.
- Payments are made directly to the provider.
What is a nonparticipating dentist?
- A nonparticipating dentist may charge more than the prevailing fee. In such cases, United Concordia will pay only 100%, 80% or 50% of the total allowable fee, depending on the services. The member may then have to pay a fee to the dentist, depending on the service provided. There are no controls over the fees of nonparticipating dentists.
- Payments by United Concordia will be made to the subscriber, who is then responsible for paying the dentist.
Summary of benefits:
| Stainless Steel Crowns(Caps), Prefabricated Resin Crown(Cap), Buildups, Crown(Cap) Repair | 80% Of Allowance |
| Single Crowns(Caps), Inlays, Onlays, 1 In 5 Years | 80% Of Allowance |
| Palliative Treatment(Emergency Pain Relief), Simple Extractions, Endodontics(Root Canals) | 100% Of Allowance |
| Exams, 1 In 6 Months, Full Mouth X-Rays, 1 In 36 Months | 100% Of Allowance |
| Bitewing X-Rays, 1 In 6 Months | 100% Of Allowance |
| Dental Oral Surgery Services | 80% Of Allowance |
| Medical Oral Surgery Services | 80% Of Allowance |
| Fillings, No Alternate Benefit For Posterior Resin Fillings | 100% Of Allowance |
| Orthodontic(Braces) Treatment, Any Age | 50% Of Allowance |
| Orthodontic(Braces) Lifetime Maximum | $1200 Per Person |
| Calendar Year Program Maximum | None |
| Calendar Year Program Deductible | None |
| Surgical And Non Surgical Periodontic (Gums) Services | 50% Of Allowance |
| Cleanings, 1 In 6 Months, Fluoride Under Age 19, 1 In 6 Months | 100% Of Allowance |
| Sealants, under age 16 on permanent first and second molars, 1 in 3 years | 100% Of Allowance |
| Space Maintainers Under Age 26 On Primary And Permanent First Molars | 100% Of Allowance |
| Denture Adjustments, Denture Repairs, Relining And Rebasing | 50% Of Allowance |
| Fixed And Removable Prosthetics(Bridges, Dentures) | 50% Of Allowance |
| Implant Related Crowns(Caps) | 50% Of Allowance |
| Implants | 25% - 50% Of Allowances In Network/ 25% Of Allowance Out Of Network |