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dental plan optIons
unitED ConCorDia PPo DEntal Plan
United Pacific is offering a Preferred Provider Organization (PPO) dental plan through United Concordia. This PPO
dental plan allows you the flexibility to visit dentists that are inside and outside of the United Concordia network.
When you utilize a “Network” dentist, your out-of-pocket expenses are typically less than using a “Non-Network”
dentist. Staying in the network allows you to benefit from the negotiated network rates. You may obtain services
using a non-network dentist, however, you may be responsible for additional charges or even filing claims.
PPo
neTwoRk non-neTwoRk*
Annual Maximum Benefit $1,500 per Person
Calendar Year Deductible
Individual $50
Family $150
Preventive Services 100% 100%
Plan Pays Deductible waived Deductible waived
Basic Services Deductible, 80% Deductible, 80%
Plan Pays
Major Services Deductible, 50% Deductible, 50%
Plan Pays
orthodontia 50% to $1,500 Lifetime Maximum
Child / Adult Deductible waived
*Based on fee schedule.
EMPloyEE ratE PEr PayChECk
(based on 26 pay periods)
Employee Only $18.63
Employee + Spouse $37.13
Employee + Child(ren) $39.57
Employee + Family $63.36
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