Page 9 - Hickory Crawdads 2022 Flipbook

DENTAL COVERAGE

You save money when using providers who
participate in United Concordia’s Elite Plus

Network, as out of network providers can bill
over maximum allowable charge that United
Your Dental Plan – United Concordia will allow which means that the
Concordia provider may bill you the difference.

It’s important to have regular dental To check for participating providers, go to:
exams and cleanings so problems are www.unitedconcordia.com
detected before they become
painful—and expensive. Keeping
your teeth and gums clean and
healthy will help prevent most tooth
decay and periodontal disease and is
an important part of maintaining your Benefit In-Network Out of Network
medical health.
The Hickory Crawdads’ dental plan is Annual Deductible $50 Individual $50 Individual
through United Concordia. You do not $150 Family $150 Family
need to elect medical to enroll in
dental coverage.
Annual Maximum
Your dental plan provides coverage (Per Person) $1,500 $1,500
for routine exams and cleanings and
pays for a portion of other services, as
shown in the displayed table chart. Class I: Diagnostic and Preventive 100% 100%
Includes Exams, Cleanings and
Fluoride Treatments (No Deductible) (No Deductible)
United Concordia Dental’s standard
exclusions and limitations apply. Class II: Basic Services
Includes Fillings, Periodontics, 80% after Deductible 80% after Deductible
Endodontics, Complex Oral Surgery

Class III: Major Services
Includes Inlays, Onlays, Crowns, 50% after Deductible 50% after Deductible
and Prosthetics

50% after Deductible 50% after Deductible
Orthodontia $1,500 Lifetime $1,500 Lifetime
(Dependent Children up to Age 19)
Maximum Maximum

The above is a brief summary of this benefit option.

Click here for more detailed information on this available benefit option.

2022 Hickory Crawdads Benefit Guide Page 9