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||50% In Network/25% Out of Network Allowance|