Understanding Alternate Benefit Provision

The Alternate Benefit Provision helps determine how payment will be made when there are two or more clinically acceptable dental services available to satisfactorily correct the same dental condition.  This provision states that United Concordia will provide coverage for the less expensive service available, while still ensuring that you receive the quality care you need for a healthy smile.

Example 1:  If you need a filling for any of your back molars, you would pay the applicable deductible and copayment, and United Concordia would pay the remainder up to the allowance for the amalgam (silver-colored) filling.  If you and your dentist choose to use a composite resin (tooth-colored) filling, the program would still cover up to the allowance for the amalgam filling (alternate benefit) and you would be responsible for paying your dentist the difference in cost between the amalgam and the composite resin fillings.

Example 2: Often a cracked tooth can be repaired using a four-surface filling.  If you and your dentist decided to use a crown, the plan would pay its share of the allowance for the four-surface filling and you would be responsible for paying the difference.

It’s important to discuss all of your options with your dentist prior to treatment.  If a proposed treatment plan is estimated to cost $200 or more, United Concordia encourages you to ask for a predetermination.  Your dentist will submit the information to United Concordia and you will receive a breakdown of how much the plan covers and how much you will have to pay, helping you make the most of your dental plan. 

Other Benefits Briefs
Understanding Coverage for Fillings
Understanding Coordination of Benefits
About United Concordia’s Network

We also have a library of Dental Health 101 articles for you and your employees’ information.  Please feel free to use these in your publications/communications as well.