United Concordia-Federal Employees

ABO Home Page ABO Home Page

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

Question Categories

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. New employees, previously ineligible employees who transfer to a covered position and survivor annuitants if not already covered under FEDVIP can enroll within 60 days of becoming eligible. In addition, eligible employees can enroll within 60 days after returning to service following a break in service of at least 31 days or after a qualifying life event that allows enrollment.

When does coverage start?
The upcoming coverage period will begin on January 1, 2008. Subsequent coverage periods for FEDVIP will be on a calendar year basis from January 1st to December 31st. (The initial coverage period for FEDVIP was December 31, 2006 through December 31, 2007.)

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.

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.

Back to Top  |   Enrollment   |  Benefits  |   Cost  |   Network
   Coordination of Benefits   |  General Questions


Benefits

Has anything changed for 2008?
Yes! For 2008, we've significantly lowered the annual deductible on Class B and C services to $25 for an individual and $50 for a family.

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. You can also refer to the Program Guide 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).

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 $1,200 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 is found on the reverse side of the EOB. It 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 $200. 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.

What is the dental accident benefit?
United Concordia provides an additional benefit, with a separate $2,000 lifetime maximum per covered person, that covers certain dental procedures that are the direct result of an accident occurring while you are enrolled in United Concordia's FEDVIP. United Concordia will pay 100% of the program allowance for those covered services specifically related to the accident, subject to the $2,000 dental accident lifetime maximum per covered person. You can see the list of the procedure codes that are covered here.

 

Back to Top  |   Enrollment   |  Benefits  |   Cost  |   Network
   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.

 

Back to Top  |   Enrollment   |  Benefits  |   Cost  |   Network
   Coordination of Benefits   |  General Questions


Network

Can I visit any dentist?
To help ensure that you and your covered family members receive quality, affordable dental care, you must receive services from a dentist in our National Fee-for-Service network.

What happens if I have an emergency when traveling and I can't find a dentist in the United Concordia National Fee-for-Service network?
If you have a dental emergency and cannot visit your National Fee-for-Service dentist, you may visit any licensed dentist and United Concordia will cover emergency (palliative) treatment.

A dental emergency is defined as an acute condition occurring suddenly and unexpectedly, which usually includes pain, swelling or bleeding, and demands immediate professional dental services.

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) 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 Nominate Your Dentist form. 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.

What if I want to visit a different dentist?
You can! As long as the dentist is in United Concordia's National Fee-for-Service network, you can change your dentist at any time and still receive coverage.

Can members of the same family go to different dentists?
Yes. But they must be United Concordia National Fee-for-Service network dentists to receive any covered benefits.

What if I need to see a specialist?
If you need to see a specialist, you can see any specialist as long as he/she participates in the United Concordia National Fee-for-Service network. However, there are a few exceptions, including emergency and international care. 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 treatment to know what your out-of-pocket costs might be.

Does the specialist have to be in the United Concordia National Fee-for-Service network?
Yes. However, there are a few exceptions, including emergency and international care.

Will I need a referral from my dentist to visit a specialist?
No. You can visit any specialist in the National Fee-for-Service network.

Do I need to take a claim form when I visit the dentist?
No. One of the benefits of visiting a National Fee-for-Service provider is that they will take care of all the paperwork for you.

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 deductibles and coinsurance amounts, but they cannot balance-bill you for the difference between their standard charges and the MACs.

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).

What is meant by “limited access area?” How do I find out if I live in one of these areas?
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 out-of-network costs for covered services to ensure convenient access to care.

This means that if you live in a limited access area, you can visit any dentist. Applicable coinsurance, deductibles, maximums and other benefit features apply. You are also responsible for any difference between the amount billed and our allowable charge.

You can find out if you live in a limited access area by going to The Right Network page.

My family also has coverage through the TRICARE Dental Program (TDP). Can I continue to see the same dentist if I enroll in FEDVIP?
To make sure you receive coverage through United Concordia's FEDVIP, be sure that the dentist is a member of the National Fee-for-Service network before you enroll in United Concordia's FEDVIP. Unlike the TDP, the United Concordia's FEDVIP is a network-only plan, which means that you must visit a network dentist for the coverage to apply. The dentist you currently see through TDP may not necessarily be a participating dentist in the network.

 

Back to Top  |   Enrollment   |  Benefits  |   Cost  |   Network
   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. The actual reimbursement depends on the participation status of the dentist with the primary plan.

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. FEDVIP is not intended to replace any existing coverage.

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?
It is your participating dentist's responsibility to submit a claim to United Concordia for coordination of benefits.

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. If this detail is not available, 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.

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.

 

Back to Top  |   Enrollment   |  Benefits  |   Cost  |   Network
   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). If you're new to United Concordia, call 1-877-GET-UCCI.

Back to Top  |   Enrollment   |  Benefits  |   Cost  |   Network
   Coordination of Benefits   |  General Questions

 

 
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.
 
Enroll Now
Go to www.benefeds.com
Go to www.opm.gov


 

| Diversity | Integrity Process | Privacy Policy | Text-Only Version |

Entire Contents © 2008 United Concordia Companies, Inc.
All Rights Reserved

 

United Concordia