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World Class Service - Frequently Asked Questions United Concordia-Federal Employees
 

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Enrollment   |  Benefits  |   Cost  |   Network
Coordination of Benefits |  General Questions


Questions by Category  (click on any question to go to its answer)

      Enrollment

      Benefits

      Cost

      Network

      Coordination of Benefits

      General


Enrollment

I am currently enrolled in United Concordia's FEDVIP. Do I need to enroll again during open season to maintain my dental benefits for the next year?
No, you do not need to enroll again to maintain your coverage in United Concordia's FEDVIP. To keep your dental benefits hassle-free, your current coverage will automatically renew from year to year, unless you make a change during open season or make a change outside of open season as a result of a qualifying life event.

How do I enroll?
During open season, go to www.BENEFEDS.com. and follow instructions for selecting United Concordia's FEDVIP.

When does coverage start?
The upcoming coverage period will begin on January 1, 2010. Coverage periods for FEDVIP will be on a calendar year basis from January 1st to December 31st.

Is there a waiting period?
There is no waiting period for eligible dental services, except for a 24-month waiting period for eligible dependents under the age of 19 years for orthodontic services.

What if I miss the open enrollment period - can I still sign up for the program?
No, you will have to wait for the next open season. There are some exceptions. Enrollment can take place during times other than the designated open season if there is a qualifying life event such as a change in marital status, birth of a child, change of employment, etc. For additional information, go to www.BENEFEDS.com.

What family members and dependents are eligible for the dental plan?
Eligible family members include an enrollee's spouse and unmarried dependent children up to age 22, or older if incapable of self-support.

I need to make changes to my enrollment information. How do I do this?
You must use BENEFEDS to enroll or change enrollment in a FEDVIP plan. BENEFEDS is a secure enrollment website (www.BENEFEDS.com) sponsored by OPM where you can enter your name, personal information, the agency you work for (or retirement system that pays your annuity), and your chosen dental plan. If you do not have access to a computer, call 1-877-888-FEDS (1-877-888-3337) to enroll or change your enrollment.

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   Coordination of Benefits   |  General Questions


Benefits

Has anything changed for 2010?
Yes! For 2010, the annual maximum has increased to $3,500 and members can visit any licensed dentist! However, because visiting a network dentist can save you money, our National Fee-for-Service network makes it easy to find a dentist near you, with more than 128,000 total dentist locations nationwide.

How often can I go to the dentist for a routine cleaning/check-up?
Twice a year.

How do I know if a service is covered or not?
First, check The Right Plan page, where you will find the Benefits Summary. United Concordia's FEDVIP brochure for a more detailed explanation of coverage and services. Always consult with your dentist on treatments and request a predetermination when you need to know whether or not a service is covered and how much you can expect to pay out-of-pocket. You can also call United Concordia's customer service representatives at 1-877-FYI-UCCI (1-877-394-8224) Monday - Friday, 8 a.m. to 8 p.m., ET.

What is an annual maximum?
It's the maximum dollar amount a program will pay toward the cost of dental care incurred by an individual during a specified time period. The annual program maximum per individual under United Concordia's FEDVIP is $3,500 per calendar year.

What is a lifetime maximum?
A lifetime maximum is the maximum amount of benefit you or your covered dependent(s) can receive toward a specific service or group of services. United Concordia's FEDVIP has a $1,500 lifetime maximum for orthodontic services and a $2,000 lifetime maximum for dental accident services.

What is an EOB?
An EOB is an Explanation of Benefits statement sent to members each time a dental claim is processed by United Concordia. The EOB displays the expenses submitted by the dentist and how the claim was processed.

The EOB has four major sections:

- Claim information includes the member and patient name, ID number and the specific claim number. It also identifies the dental care facility or dentist.

- Service and coverage information identifies dates of services and charges and shows the amount paid, applicable discounts and deductions and the total expense that was not covered.

- Explanations may be included to provide additional information on the above sections. For example, if a claim was not paid in full, the EOB notes what benefit limitations or exclusions apply.

- Patient summary details the benefit period, the amount applied to the individual annual program maximum and the group number.

What is a predetermination?
A predetermination lets you and your dentist know what will be covered, how much the plan covers, how much you can expect to pay, as well as any alternate treatment options available for a proposed treatment plan. United Concordia recommends that you ask your dentist for a predetermination for all proposed dental treatments over $500. Just ask your dentist and he or she will submit information about the proposed treatment to us and we'll send you both a predetermination.

Implant prosthetics are listed as covered under Class C services. What is an implant prosthetic?
An implant is typically composed of two main parts: a post that is attached to the jawbone (to simulate the root of the tooth) and a crown that is placed on top of the post. If you and your dentist choose to replace a single missing tooth with an implant, United Concordia will provide coverage for the crown (or “prosthetic”) that goes on top of the implant post. Please refer to the United Concordia Program Guide for a list of implant-related procedure codes that are covered under the plan. Also, be sure to request a predetermination before treatment so you'll know upfront how much your plan covers and how much you'll have to pay.

The image below shows the two main parts of an implant:

What is the missing tooth provision?
The missing tooth provision means that if you have a tooth missing when you start your United Concordia FEDVIP coverage, United Concordia FEDVIP will not cover the cost of replacing that tooth, whether through a bridge, denture or other prosthetic.

 

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   Coordination of Benefits   |  General Questions


Cost

What are the premiums for United Concordia's dental program?
The premiums vary by location or rating area. A rating area is a group of zip codes that corresponds to a particular rate charged. Go to The Right Price page and use your residential zip code to determine your premium.

How do I pay the premium?
Employees pay premium through payroll deduction, with pre-tax dollars. Annuitants pay via deductions to annuity payments.

Does the federal government contribute to a portion of the cost?
No, by law there is no government contribution. Enrollees are responsible for 100% of the cost, but premiums are competitive since insurance is purchased on a group basis.

 

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   Coordination of Benefits   |  General Questions


Network

Can I visit any dentist?
Beginning in 2010, United Concordia FEDVIP members will be able to choose any licensed dentist. This will allow you to keep your current dentist, even if the dentist is not part of our network. However, there are several benefits to visiting a network dentist, and with more than 128,000 total dentist locations across the country, no matter where you are, finding a United Concordia National Fee-for-Service (NFFS) network dentist is easy. Just use our Find a Dentist online network dentist search tool.

View information on limited access areas.

I am not located in the United States...can I still receive coverage?
You can receive coverage for care provided by any dentist outside of the United States.

How do I find a dentist?
To find a National Fee-for-Service network dentist, go to the Find a Dentist page. You can search by last name, specialty, city, county or zip code. You can also call United Concordia at 1-877-FYI-UCCI (1-877-394-8224) Monday - Friday, 8 a.m. to 8 p.m., ET, and our customer service representatives will assist you with information regarding a dentist's participation status, specialty and office location.

If my current dentist is not in the National Fee-for-Service network, can I request that he/she becomes a United Concordia dentist?
Yes! We gladly accept nominations for new network dentists. To nominate a dentist, simply complete and submit the Nominating Your Dentist form under Forms & Publications. Your current dentist can also obtain an application to participate in the National Fee-for-Service network by calling our toll-free customer service line or by downloading the application.

Can members of the same family go to different dentists?
Yes. Members of the same family can visit different dentists, even if the dentist is not in the National Fee-for-Service network. However, visiting a network dentist can save you money. Visit the Right Network page to see an example of your potential savings.

View information on limited access areas.

What if I need to see a specialist?
If you need to see a specialist, you can see any specialist; however, there are a few exceptions, including limited access areas and international care. Also, your costs may be greater if you visit a non-network specialist. It's always a good idea to discuss treatment options with your dentist and specialist before receiving a service. Also, be sure to request a predetermination of costs before extensive treatment to know what your out-of-pocket costs might be.

View information on limited access areas.

Will I need a referral from my dentist to visit a specialist?
No. You do not need a referral from your dentist to visit a specialist. Visiting a network specialist could help keep your out-of-pocket costs down. To find a National Fee-for-Service specialist, use Find a Dentist.

Do I need to take a claim form when I visit the dentist?
If you visit a National Fee-for-Service dentist, you do not need to take a claim form, as our network dentists have agreed to file claims for you. However, it is a good idea to bring a claim form if you are visiting a non-network dentist. You can print one from our Forms & Publications page.

For what amounts can a dentist bill me?
United Concordia National Fee-for-Service network dentists accept our reimbursements, also known as maximum allowable charges (or MACs), as payment-in-full for covered services. United Concordia National Fee-for-Service network dentists can charge you for applicable coinsurance amounts, but they cannot balance-bill you for the difference between their standard charges and the MACs. Non-network dentists can bill you for the difference between their standard charges and the MACs, which means you could save more by visiting a network dentist.

What if I have a question on a bill or service that I receive from my dentist?
First, talk with your dentist. If you still have questions or concerns, call United Concordia's customer service representatives at 1-877-FYI-UCCI (1-877-394-8224) Monday - Friday, 8 a.m. to 8 p.m., ET.

What is meant by “limited access area?” How do I find out if I live in one of these areas?
Please remember that as a FEDVIP member, you may visit any licensed dentist, but you could save more money by visiting a network dentist. However, FEDVIP members that live in an area specifically defined as a limited access area may visit any dentist.*

Limited access areas are geographic regions in which OPM has identified a smaller number of network providers in proportion to the federal employee population. While United Concordia has participating dentists in many of these areas, the plan benefits are extended to non-network costs for covered services to ensure convenient access to care.

To view the list of approved limited access areas, visit The Right Network page.

* Applicable coinsurance, maximums and other benefit features still apply. The member is also responsible for any difference between the amount billed and our allowable charge.

My family also has coverage through the TRICARE Dental Program (TDP). Can I continue to see the same dentist if I enroll in FEDVIP?
Yes. Both programs use the National Fee-for-Service network. However, beginning in 2010, United Concordia FEDVIP members will be able to choose any licensed dentist, although visiting a network dentist could help to reduce your out-of-pocket costs. You can search for a National Fee-for-Service network dentist using our Find a Dentist tool.

 

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   Coordination of Benefits   |  General Questions


Coordination of Benefits

What is coordination of benefits (COB)?
Coordination of benefits is a method by which two or more carriers or plans coordinate their respective benefits so the total benefit paid does not exceed 100% of the total expenses incurred. The purpose of COB is to allow patients to receive the highest level of benefits that they are entitled to.

United Concordia coordinates benefits payments with:

  • FEHB - If you have dental coverage through both an FEHB plan and FEDVIP, your FEHB plan is the first payor of any benefit payments. Please ask your dentist to submit the charges to your FEHB plan. Please note that it is not your responsibility to submit any claim information or an explanation of benefits (EOB) to United Concordia.  If no EOB is received, United Concordia will coordinate benefits by estimating the amount the FEHB plan will pay.

  • Non-FEHB carriers - If you are the policy holder for both FEDVIP and a commercial carrier, the plan that has been in effect the longest is primary.

  • Group health benefits carriers.

  • No-fault insurance carriers that pay benefits without regards to fault.

United Concordia is the primary payor if we do not have an indication of other insurance on our enrollment files and there is no indication of other insurance on the claim form.

For more information, please see United Concordia's FEDVIP brochure on the Forms & Publications page.

My FEHB medical plan covers some dental services. If I enroll in FEDVIP, will that replace my FEHB coverage?
No. Any coverage provided under your FEHB medical plan remains as your primary coverage, meaning that claims have to be submitted to the medical plan first. FEDVIP coverage would pay secondary to that coverage, and is not intended to replace any existing coverage. Your dentist should include any explanation of benefits (EOB) statement received from FEHB with the claim form when submitting to United Concordia.

If I enroll in FEDVIP, will my FEHB plan reduce my premiums because I will no longer use my FEHB plan's dental benefits?
No. Your FEHB plan will still be the primary payor for your dental care up to the limits of its coverage.

Why should I enroll in FEDVIP when I already have dental coverage with my FEHB plan?
United Concordia's FEDVIP provides comprehensive dental coverage beyond diagnostic and preventive care like your annual cleanings and exams. It also offers extensive coverage for intermediate and major services like fillings, oral surgery, periodontal care, crowns and even dental accident coverage.

I am enrolled with the TRICARE Dental Program (TDP) and FEDVIP. I do not have FEHB coverage. How will COB apply?
In this instance, FEDVIP will process the claims as primary and TDP will process as secondary.

Who is responsible for submitting a claim to United Concordia for coordination of benefits?
One of the benefits of visiting a network dentist is that your dentist will handle all of your paperwork for you. However, if you visit a non-network dentist, you are responsible for submitting a claim form and any explanation of benefits (EOB) statement received from FEHB to United Concordia.

What if my FEHB health insurance is a dental HMO and I cannot get an explanation of benefits statement from them?
If the EOB is not available, the participating dentist may indicate the amount paid for each reported service by the primary carrier on the claim form. In the absence of this detail, the participating dentist may indicate the total amount paid by the primary carrier on the claim form. If you paid a copayment for a service, this should also be noted on the form. If no information on payment is available, United Concordia will coordinate benefits by estimating the amount the FEHB plan will pay.

How is the primary dental plan determined between FEDVIP and dental insurance other than FEHB?
If you have FEDVIP coverage and additional coverage through your spouse, FEDVIP is primary for you and your spouse's coverage is secondary. Your spouse's coverage is primary for him or her and your FEDVIP coverage is secondary. If you have dependent children, usually the plan of the parent with the earliest date of birth (month and day only) pays first for the children. If you are the policy holder for both FEDVIP and a commercial carrier, the plan which has been in effect the longest would be primary.

I want FEDVIP to be primary to my FEHB plan for coordination of dental benefits. How do I make this happen?
By law, FEDVIP must be secondary to the FEHB plan. Your FEDVIP coverage cannot be primary to dental coverage offered through your FEHB plan.

 

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   Coordination of Benefits   |  General Questions


General

What is FEDVIP?
The Federal Employees Dental and Vision Insurance Program (FEDVIP) is available to eligible federal and postal employees, retirees and their eligible family members on an enrollee-pay-all basis. This program allows dental and vision insurance to be purchased on a group basis, which means you receive comprehensive coverage at competitive premiums.

Employees must be eligible for FEHB in order to be eligible to enroll in FEDVIP. It does not matter if an employee is actually enrolled in FEHB - eligibility is the key. Annuitants are eligible to enroll in FEDVIP no matter what their FEHB status is.

I see references to FEHB and FEDVIP. What is FEHB?
FEHB stands for the Federal Employees Health Benefits (FEHB) Program. The FEHB Program is the largest employer-sponsored group health insurance program in the world, covering over 9 million Federal employees, retirees, former employees, family members and former spouses. If you have questions about FEHB coverage, please contact your Agency Benefits Office.

I do not speak English. Do you have a translator?
Yes, we have bilingual English/Spanish customer service representatives. We also have translation services for 140 other languages.

What if I have other questions or concerns regarding the United Concordia FEDVIP?
Questions about your dental treatment should first be discussed with your dentist. If you have questions about eligibility, enrollment or premium deductions, please contact BENEFEDS. If you have general questions or would like clarification on your benefits, please call Customer Service at 1-877-FYI-UCCI (1-877-394-8224). Monday - Friday, 8 a.m. to 8 p.m., ET. If you're new to United Concordia, call 1-877-GET-UCCI (1-877-438-8224) Monday - Friday, 8 a.m. to 8 p.m., ET.

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   Coordination of Benefits   |  General Questions

 

 
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If you are currently enrolled in United Concordia FEDVIP, call 1-877-FYI-UCCI (1-877-394-8224). If you are new to United Concordia FEDVIP, call 1-877-GET-UCCI (1-877-438-8224) for assistance specifically dedicated to your new questions.

 

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