Dental Plan for Active Employees

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 Not Covered
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