Dental Plan – United Concordia
The dental plan covers preventive care including regular checkups, as well as fillings and other dental procedures. You may visit any dentist you choose, but you’ll receive a higher level of benefits when you go to an in-network dentist.
Providers participating in the Concordia Advantage Plus Network are considered in-network providers under this plan. Reimbursements made by the plan are based on maximum allowable charges (the “allowance”) assigned to each specific service type. In-network providers will accept United Concordia’s allowance as payment in full. Out-of-network providers may bill the member for the difference between United Concordia’s allowance and their actual charges. (This is in addition to any co-insurance that is the member’s responsibility.)
United Concordia Dental for CCM Employees
| IN-NETWORK | |
| Calendar Year Deductible | |
| Individual | $25 |
| Family | $75 |
| Calendar Year Out-of-Pocket Maximum | |
| Per Individual | $1,500 per individual (Basic and Major Services combined) |
| You Pay | |
| Preventive Care | |
| Exams, Cleanings, X-rays, Fluoride Treatments | $0 |
| Basic Services | |
| Fillings, Space Maintainers, Sealants, Extractions, Oral Surgery, Endodontics, Periodontics, Emergency Exams | 20%* |
| Major Procedures | |
| Crowns, Inlays/Outlays, Dentures and Bridgework, Repairs | 50%* |
| Orthodontia | |
| 24-Month Treatment Fee ⎯ Additional fees will apply for pre-ortho visits and treatment, records and retention, and banding | |
| Adults | 50% up to a lifetime maximum benefit of $1,000 per individual; deductible waived |
| Children | 50% up to a lifetime maximum benefit of $1,000 per individual; deductible waived |