Carrier: United Concordia – Concordia Flex
- The coverage is effective the first day of month following your date of benefit eligible employment.
- Dependent children covered to age 26
- In-network and out-of-network benefits
- $1,500 maximum benefit per member per calendar year
- $50 individual
- $100 family
Level of Coverage for each Benefit Category
If enrolled as a late entrant in the first twelve months that an employee and dependents are insured, the only available coverage will be for exams, cleanings and fluoride application (Class 1)
|Diagnostic and Preventative Services|
|100%||Exams (twice in any 12 consecutive months)|
|100%||Cleanings (twice in any 12 consecutive months)|
|100%||Fluoride application – age 18 and under (once in any 12 consecutive months)|
|100%||Sealants (limited permanent first molars once during a 3 year period for persons age 16 and older)|
|100%||Bitewing x-rays (limited to 2 allowances in a calendar year)|
|100%||Palliative emergency treatment|
|100%||Full mouth x-rays (once in any 36 consecutive months)|
|80%||Complex oral surgery|
|50%||Inlays, onlays and crowns|
|Orthodontics (dependents to age 19)|
|50%||Diagnostic, active and retention treatment|
|$1,500||Orthodontic lifetime maximum|
* The level of coverage percentage shown above is based upon United Concordia’s Maximum Allowable Charge (MAC). Participating providers will accept United Concordia’s allowance as payment in full (less any deductible or coinsurance amounts that are the member’s responsibility). The network of participating providers for this program is Advantage Plus. Using a non-participating provider may result in additional out-of-pocket expenses.
The maximum benefit per calendar year per participant is $1,500.
Note: If you do not sign up for the dental insurance when you are first eligible, you will be considered a late entrant and will have coverage for Class 1 services only for the first 12 months. After the 12-month waiting period, you will have coverage for all services.
Visit the United Concordia website at www.unitedconcordia.com.
** For detailed information regarding your benefit coverage, please visit the HR website on CONNECT.