| |
United Concordia’s FEDVIP offers the dental
benefits needed to keep your employees and annuitants
smiling for a lifetime.
Our plan covers:
- Diagnostic and preventive dental care
(routine cleanings and exams)
- Intermediate and major services
(fillings and crowns),
with no waiting periods
- Emergency treatments
- Orthodontics for dependents
In addition, members enjoy quality dental
care and out-of-pocket savings when visiting
a United Concordia network dentist. Services provided
by non-network dentists are not covered by the
United Concordia FEDVIP.
Remember! Members must use a United Concordia
National Fee-for-Service Network dentist.
In general, services provided by non-network
dentists are not covered. However, there are
a few exceptions, including emergency and overseas care.
|
| 2009 Benefit Summary |
| Plan Design1 |
Plan Pays2 |
You Pay |
|
 |
Exams |
X-rays |
Cleanings |
Fluorides |
Sealants |
Space Maintainers |
| Emergency Care |
Dental Accident Services
|
|
100% |
0% |
|
 |
| Minor Restorative Services |
Nonsurgical Endodontic Services |
Nonsurgical Periodontal Services |
| Prosthodontic Services |
| Oral Surgery |
| General Anesthesia |
| Consultations |
| Miscellaneous Services |
|
80% |
20% |
|
 |
| Major Restorative Services |
| Surgical Endodontic Services |
| Periodontal Surgery |
| Prosthodontic Services |
|
50% |
50% |
|
 |
|
Diagnostic, Limited, Interceptive, Comprehensive, Retention Treatments |
50% (Dependents to 19) |
|
 |
| Medications - Therapeutic Drug Injections |
Eligibility related to
above covered services |
|
 |
| Annual Program Maximum (per person) |
$1,200 |
| Lifetime Orthodontic Maximum (per person) |
$1,500 |
| Dental Accident Lifetime Maximum (per person) |
$2,000 |
|
1. Please review the United Concordia program
guide for a full explanation of plan benefits,
including Exclusions and Limitations. You
can access it on the
Forms & Publications page.
2. Plan covers services provided by network dentists
only, except for emergency and international
care. Percentages applied to lesser of United
Concordia's negotiated fees (maximum
allowable charges) and dentist's average
charge.
3. 24-month waiting period for Class D services.
|
|
|
|
