United Concordia’s FEDVIP offers the dental
benefits needed to keep your employees and annuitants
smiling for a lifetime.
| Covered Dental Services |
United Concordia Pays2 |
|
| Plan Design1 |
In-Network |
Out-of-Network |
|
 |
Exams |
X-rays |
Cleanings |
Fluorides |
Sealants |
Space Maintainers |
Emergency Care
|
|
100% |
80% |
| Dental Accident Services |
100% |
100% |
|
|
Intermediate Services - Class B |
Minor Restorative Services -
(Fillings, Stainless Steel Crowns through age 14)
|
Nonsurgical Endodontic Services -
(Pulpal Therapy)
|
Nonsurgical Periodontal Services -
(Periodontal Scaling, Root Planing, Periodontal Maintenance) |
Prosthodontic Services -
(Denture repair) |
| Oral Surgery |
| General Anesthesia |
| Consultations |
| Miscellaneous Services |
|
80% |
60% |
|
|
Major Services - Class C |
Major Restorative Services -
(Crowns, Inlays, Onlays, Posts, Cores, Single Implant Crowns) |
Surgical Endodontic Services -
(Root Canals, Apicoectomies) |
Periodontal Surgery -
(Gingivectomies, Osseous Surgery) |
Prosthodontic Services -
(Posts, Cores, Dentures, Bridges) |
|
50% |
40% |
|
|
Orthodontic Services - Class D3 |
|
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) |
Now $3,500! |
| Lifetime Orthodontic Maximum (per person) |
$1,500 |
| Dental Accident Lifetime Maximum (per person) |
$2,000 |
|
1. Please review the United Concordia Dental Program Guide for a
full explanation of plan benefits including exclusions and limitations.
You can access it at www.uccifedvip.com.
2. Percentages applied to lesser of United Concordia's negotiated
fees (maximum allowable charges or MAC) and dentist's average charge.
As out-of-network dentists do not agree to accept our MAC, they may bill you
the difference between our MAC and their regular fees.
3. 24-month waiting period for Class D services.
|
