Page 7 - MyPoint EE Guide

BENEFITS

Dental Insurance

United Concordia | DHMO United Concordia | PPO
With the Dental Health Maintenance Organization (DHMO) plan through With the United Concordia Preferred Provider
United Concordia, you are required to select a general dentist who is a Organization (PPO) dental plan, you may visit a PPO
member of the DHMO network to provide your dental care. You will dentist and benefit from the negotiated rate or visit
contact your general dentist for all of your dental needs, such as routine a non‐network dentist. When you utilize a PPO
check‐ups and emergency situations. If specialty care is needed, your network dentist, your out-of-pocket expenses will
general dentist will provide the necessary referral. For covered be less. You may also obtain services using a non-
procedures, you'll pay the pre‐set copay or coinsurance fee described in network dentist; however, you will be responsible
your DHMO plan booklet. Please keep a copy of your booklet to refer to for the difference between the covered amount and
when utilizing your dental care. This will show the applicable copays that the actual charges and you may be responsible for
apply to all of the dental services that are covered under this plan. filing claims.

United Concordia United Concordia
Plan Name DHMO PPO with Wellness
Network Name DHMO Concordia Plus ElitePlus Non-Network
Dental Benefits

Calendar Year Maximum Benefit Unlimited $5,000 $5,000
Calendar Year Deductible
- Individual $0 $25 $25
- Family $0 $75 $75

Preventive No Charge for Most Services No Charge No Charge*
Basic Services See Copay Schedule Deductible, 10% Deductible, 20%*
Major Services See Copay Schedule Deductible, 40% Deductible, 50%*
Orthodontia (Children & Adults)
- Child(ren) $1,500 Copay 50% - $2,000 Lifetime Benefit Maximum
- Adults $2,000 Copay 50% - $2,000 Lifetime Benefit Maximum
*Dentists who are out-of-network have not agreed to pricing, and may bill you for the difference between what United Concordia
pays them and what the dentist usually charges.

PPO Dental Wellness Benefit:
As a PPO enrollee, if you have been diagnosed with one of the following chronic medical conditions, you are eligible for improved
Periodontal dental benefits through the Smile for Health Wellness benefit:
• Cerebral Vascular Disease (including Stroke) • Oral Cancer
• Cardiovascular (Heart) Disease • Organ Transplant
• Diabetes • Rheumatoid Arthritis
• Lupus

To register, visit www.unitedconcordia.com/getmdb. Sign in or create an account, click on the Wellness tab, and click the +Add a
new condition button and complete the fields as prompted.

Finding a Dental Provider
Go to www.unitedconcordia.com or call (800) 357-3304 for DHMO or (800) 332-0336 for DPPO. DHMO
participants should refer to the “DHMO Concordia Plus” network, and PPO participants should refer to the
“Elite Plus” network when prompted .

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