Page 60 - 2022 Large Group benefits

Dental plans
All dental dental plans
are sold and and and administered by United Concordia Companies Inc and and and allow flexibility network network access and and and and ease of of of administration from one of of of the nation’s largest PPO dental dental dental networks The following dental dental plans
plans
are a a a a a a a a a a a a a a a a a a a sample of of of all plans
plans
available to to both 51–99 and and 100+ customers Concordia Flex Dental Benefit category1
Class 1 — Diagnostic/ Preventive services
In/Out-of-network2
Exams
X-rays
Cleanings & fluoride treatments Sealants
Space maintainers
Emergency treatment Fillings (metal and white fillings)
Simple extractions
Repairs of crowns inlays onlays bridges & dentures Endodontics
Surgical and nonsurgical periodontics
Complex oral surgery
General anesthesia
Inlays onlays crowns Prosthetics (bridges dentures)
Diagnostic active retention treatment Annual program deductible (per person/per family) Annual program maximum (per person)
Lifetime orthodontic maximum (per person)
100% 100% 100% 100% 80% 100% 80% 80% 80% 80% 80% 80% 80% 50% 50% Not covered
$50/$150 Excludes Class 1 1 $1 500 Excludes Class 1 1 N/A
100% High option
In/Out-of-network2
Middle option
100% 100% Class 2
— Basic services
100% 80% 100% 80% 80% 80% 80% 80% 80% 80% Class 3 — Major services
50% Orthodontics for
dependent children to age 19
50% Maximums & Deductibles (applies to the combination of services
received from network network and non-network dentists)
50% $50/$150 Excludes Class 1 1 & Orthodontics $1 500 Excludes Class 1 1 & Orthodontics $1 500 59
United Concordia Companies Inc can can customize almost any PPO dental dental plan plan or or 100+ customers can can choose from the standard dental dental plans
• Members receive 100 percent percent coverage of of diagnostic and and preventive services
and and save an an an average of of 40 percent percent on on additional services
from providers • Pregnant members members and members members with certain conditions have access to extra periodontal benefits 3 • 100+ customers have a a a a a a a a a a dedicated Account Management team to to to help you customize deductibles and maximums or add extra benefits like cosmetic orthodontia and Smile for
Health • Self-funding is also available for
100+ customers 1 1 Unmarried dependent dependent students covered
to to to age age 26 Groups with 51+ employees can customize the age age limits for
dependents 2
2
Reimbursement is is is is based on on a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a schedule of maximum allowable charges (MACs) Network dentists dentists agree to to to accept UCD’s allowances as as as payment in in in full for
for
for
covered
covered
services
Non-
network network dentists dentists may bill bill the the the the member for
for
any difference between the the the the allowance allowance and and and and their fee (also known as as as balance billing) Dental plans
are are sold and and and and administered by United Concordia Companies Inc Standard Exclusions and and and limitations apply Other out-of-network reimbursement levels are available 3 Members (subscribers or or or or or covered
covered
dependents) with certain medical conditions must sign up for
this program through My Dental Benefits on on on on on on on on UnitedConcordia com Representative
listing of of of covered
covered
services
– certificate of of of coverage provides a a a a a a detailed description of of of benefits