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DENTAL

DENTAL

United Concordia | DHMO Plan (CA Only)

This plan requires you to select a general dentist who is a member of the network to provide your dental care. You will contact your general dentist for all of your dental needs, such as routine check-ups and emergency situations.

If specialty care is needed, your general dentist will provide the necessary referral. For covered procedures, you’ll

pay the pre-set copay or coinsurance fee described in your DHMO plan booklet. Please keep a copy of your booklet to refer to when utilizing your dental care. This will show the applicable copays that apply to all of the dental services that are covered under this plan.

United Concordia | PPO Plan

This plan offers you the freedom and flexibility to use the dentist of your choice. However, you will maximize your benefits and reduce your out-of-pocket costs if you choose a dentist who participates in the United Concordia

network. When you utilize a network dentist, your out-of-pocket expenses will be less, however, you will usually pay the lowest amount for services when you visit a PPO dentist. If you obtain services using a non-network dentist, you will be responsible for the difference between the covered amount and the actual charges and you maybe be responsible for filing claims. The chart below provides a high-level overview of your dental plan. 

Finding a dental provider Go to www.unitedconcordia.com

DHMO: Refer to the “DHMO Concordia Plus:

PPO: Refer to the “Elite Plus” Network

United Concordia DHMO (CA Only)

  In-Network Out-of-Network
Deductible (Individual/Family) $0/$0 Not Covered
Annual Maximum Benefit Unlimited
Orthodontia Lifetime Maximum Child $1,500, Adult $2,000
Type A: Preventive Care No charge for most services
Type B: Basic Care Copays Apply
Type C: Major Care Copays Apply
Orthodontia Child $1,500, Adult $2,000

United Concordia PPO

  In-Network Out-of-Network
Deductible (Individual/Family) $50/$100
Annual Maximum Benefit $1,500
Orthodontia Lifetime Maximum 50% / $1,500 Lifetime Benefit Maximum
Type A: Preventive Care No Charge No Charge
Type B: Basic Care Deductible, 20% Deductible, 20%
Type C: Major Care Deductible, 50% Deductible, 50%
Orthodontia 50% / $1,500 Lifetime Benefit Maximum
Rates & Contributions  

Employee Per Month

DHMO  
Employee only $12.50
Employee + spouse $25.00
Employee + child(ren) $25.40
Employee + family $37.80
PPO  
Employee only $29.69
Employee + spouse $59.38
Employee + child(ren) $63.54
Employee + family $96.78
United Concordia     www.unitedconcordia.com
Dental HMO   Policy #: 921276-001  
Dental PPO   Policy #: 921276-000  
Original Effective Date   1/1/2018  
Renewal Date   1-Jan  
Name Title/Role Phone Email
Member Services HMO 800-332-0366  
  PPO 866-357-3304  
Membership/Billing   888-320-3316  
Nancy Arias Client Manager 818-936-1307 [email protected]
Peggy Shank Membership/Billing 888-320-3316 [email protected]

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