Page 13 - 2021 Master's University Benefit Brochure_Final3

UCCI Dental HMO Plan

DHMO
In-Network

Annual Benefit Maximum Unlimited

Calendar Year Deductible:
Individual / Family None

Preventive & Diagnostic:
Office Exams / Cleanings / X- See fee schedule
Rays

Basic Services:
Fillings / Root Canal / Oral See fee schedule
Surgery

Major Services:
Crowns / Dentures / Bridges See fee schedule

Orthodontia $1,500 child
$2,000 adult

• You must select a United Concordia Primary Dental Office to receive covered services.

• For a complete description of your plan, please refer to your Certificate of Coverage and the

Schedule of Exclusions and Limitations in addition to this schedule of benefits.

• To find an in-network provider please visit https://www.unitedconcordia.com/find-a-dentist/#/
and use DHMO Concordia Plus as your network.

The Master’s University & Seminary Page 12
2021 Employee Benefits Brochure