Page 14 - Paragon Services Engineering 2019 Employee Benefits

United Concordia | PPO Dental Plan
With the United Concordia Preferred Provider Organization (PPO) dental plan, you may visit a PPO dentist and
benefit from the negotiated rate or visit a non‐network dentist. When you utilize a PPO dentist, your out-of-pocket
expenses will be less. You may also obtain services using a non-network dentist; however, you will be responsible
for the difference between the covered amount and the actual charges and you may be responsible for filing
claims.

United Concordia
Plan Name PPO
Network Name Elite Plus Network Non-Network
Dental Benefits

Calendar Year Maximum $1,200
Deductible (Annual)
- Individual $50
- Family $150

Preventive No Charge No Charge
Exams, X-Rays, Cleanings (UCR 90th Percentile)

Basic Services Deductible, 10% Deductible, 20%
Fillings, Oral Surgery, Endodontics, Periodontics (UCR 90th Percentile)

Major Services Deductible, 40% Deductible, 50%
Crowns, Prosthetics (UCR 90th Percentile)
Orthodontia
- Covered Members Children Only
- Coinsurance 50%
- Lifetime Benefit Maximum $1,000

Note:
We strongly recommend you ask your
dentist for a predetermination if total Finding a Dental Provider
charges are expected to exceed $300.
Predetermination enables you and your Go to www.unitedconcordia.com or call
dentist to know in advance what the (800) 332-0366. Refer to the “Elite Plus” network.
payment will be for any service that may
be in question.