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Family PPO dental plan options
Our standalone Family PPO dental plans offer coverage for children and adults, including preventive care and most basic and major dental services.
Plan benefits
Dental deductible
Annual maximum benefit (per member) Preventive services Exams/Evaluations
Cleanings
X-rays
Emergency/Palliative treatment
Fluoride treatments
Sealants
Basic services
Space maintainers
Fillings (Amalgam restorations – metal; Resin-basedcompositerestorations – white)
Simple and surgical extractions Crown and denture repair
Root canals
(Endodontic therapy and services)
Surgical and non-surgical periodontics and maintenance
Oral surgery
General anesthesia, nitrous oxide, and/or IV sedation
Major services
Crowns, inlays, onlays
Complete or fixed partial dentures (prosthetics)
Implants
Orthodontia
Cosmetic orthodontia
Preferred Family PPO3
Member pays
Member pays
Premier Family PPO3
Member pays
Member pays
Deluxe Family PPO3
Member pays
Member pays
$50 Individual, $150 Family
$50 Individual, $150 Family
$50 Individual, $150 Family
$1,000
$3,000
$3,000
$01
$01,4
$01,4
$01
$01,4
$01,4
$01
$01,4
$01,4
$01
$01,4
$01,4
Up to age 19: $01
Age 19+: Not covered (discount may apply)
Up to age 19: $01
Age 19+: Not covered (discount may apply)
Up to age 19: $01
Age 19+: Not covered (discount may apply)
Up to age 19: $01
Age 19+: Not covered (discount may apply)
Up to age 19: $01
Age 19+: Not covered (discount may apply)
Up to age 19: $01
Age 19+: Not covered (discount may apply)
Up to age 19: 50%2
Age 19+: Not covered (discount may apply)
Up to age 19: 20%2
Age 19+: Not covered (discount may apply)
Up to age 19: 10%2
Age 19+: Not covered (discount may apply)
50%2
20%2
10%2
50% 2
20%2
10%2
50%2
20%2
10%2
50%2
20%2
10%2
50%2
20%2
10%2
50%2
20%2
10%2
50%2
20%2
10%2
Member pays
Member pays
Member pays
Member pays
Member pays
Member pays
Not covered (discount may apply)
50%2
40%2
Not covered (discount may apply)
50%2
40%2
Not covered
Not covered
Not covered
Not covered
Not covered
Up to age 19: 50% coverage with a lifetime maximum of $10001
Age 19+: Not Covered
See the footnotes for the dental benefits on the next page.
Concordia Advantage network offers choice and savings
Members can visit any dental provider but pay less by choosing providers in the Concordia Advantage network, one of the nation’s largest dental networks. More participating providers means lower out-of-pocket costs for members.
The statistics presented above are taken from United Concordia Companies, Inc. Internal Research and Reports (July 2019).
*Including services that exceed a plan’s annual maximum benefit
Adult dental benefits are current at the time of publication and are subject to change. Refer to the benefit booklet for limitations and exclusions.
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