World Class Service - Frequently Asked Questions

Question Categories

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


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

      First Payor

      Enrollment

      Benefits

      Cost

      Network

      Coordination of Benefits

      General


First Payor

My FEHB medical plan covers some dental services. If I enroll in FEDVIP, will that replace my FEHB coverage?
No. When you visit a provider who participates with both your FEHB plan and your FEDVIP plan, the FEHB plan will pay benefits first. The FEDVIP plan allowance will be the prevailing charge in these cases. You are responsible for the difference between the FEHB and FEDVIP benefit payments and the FEDVIP plan allowance. United Concordia Dental is responsible for facilitating the process with the FEHB first payor. 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 Dental.

Why should I enroll in FEDVIP when I already have dental coverage with my FEHB plan?
United Concordia's FEDVIP provides additional dental coverage beyond diagnostic and preventive care (such as 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.

What if my FEHB health insurance is a dental HMO and I cannot get an explanation of benefits (EOB) statement from them?
If the EOB is not available, the participating dentist may indicate the amount paid for each reported service by the first payor on the claim form. In the absence of this detail, the participating dentist may indicate the total amount paid by the first payor 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 facilitate the process with the first payor and will estimate the amount the FEHB plan will pay.

I want FEDVIP to be the first payor of my dental benefits, not my FEHB plan. How do I make this happen?
By law, FEDVIP must be the second payor, and the FEHB plan must be the first payor. Your FEDVIP coverage cannot be first payor to dental coverage offered through your FEHB plan.


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 the instructions for selecting United Concordia's FEDVIP.

When does coverage start?
The upcoming coverage period will begin on January 1, 2012. Coverage periods for FEDVIP are on a calendar year basis from January 1st to December 31st.

Is there a waiting period?
The only waiting period under the plan is a 24-month waiting period for orthodontic services for eligible dependents under the age of 19 years.

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.

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


Benefits

How often can I go to the dentist for a routine cleaning/check-up?
Two times within a 12-month period.

How do I know if a service is covered?
First check The Right Plan page where you will find the Benefits Summary. You may also review 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 will be expected to pay for a specific dental service. 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 plan year. 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 Explanation of Benefits (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 provides the dates of services, dentist's charges, amounts paid by United Concordia, and the dentist's charges that were not covered by your plan.

- 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 (also referred to as a “Pre-D”) is a 'claim' that you submit before any services are actually rendered. It lets you and your dentist know what services will be covered, how much the plan will pay, how much you can expect to pay, and 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.

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. Implant prosthetics are listed as covered under Class C services. 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 dental accident benefit?
A dental accident is an injury to sound natural teeth and supporting structures caused by a violent external force such as a fall or blow to the mouth.

United Concordia pays 100% of the program allowance for covered services specifically related to accidental dental injuries up to a lifetime maximum of $2,000. This benefit is separate from the services covered under the annual maximum of $1,200.

 

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


Cost

What are the premiums for United Concordia's dental plan?
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 home ZIP code to determine your premium.

How do I pay the premium?
Employees pay their premium through payroll deduction, with pre-tax dollars. Annuitants pay via deductions to their 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; however, premiums are competitive since insurance is purchased on a group basis.

 

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


Network

Can I visit any dentist?
As a United Concordia FEDVIP member, you may visit any dentist. However, inside the United States and its territories, you could experience reduced out-of-pocket costs by visiting an Advantage Plus network dentist. (Please note that United Concordia does not have participating dentists outside the United States and its territories.)

There are several advantages to visiting a network dentist, and with more than 150,000 access points across the country, no matter where you are, finding a United Concordia Advantage Plus network dentist is easy. Just use our Find a Dentist online search tool.

Can I visit a dentist outside the United States and its territories?
Yes, however, please be aware that United Concordia does not have participating dentists outside the United States and its territories, so you may experience higher out-of-pocket costs when visiting these dentists.

What if I need to visit a dentist in an emergency?
As a United Concordia FEDVIP member, you may visit any dentist. However, inside the United States and its territories, you could experience reduced out-of-pocket costs by visiting an Advantage Plus network dentist.

How do I find a dentist?
To find an Advantage Plus 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 Advantage Plus network, can I request that he/she become 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 under Forms & Publications. Your current dentist can also obtain an application to participate in the Advantage Plus network by calling our toll-free customer service line at 1-877-FYI-UCCI (1-877-394-8224) 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 one or more of them are not in the Advantage Plus network. However, visiting a network dentist can save you money. Visit the Right Network page to see an example of your potential savings.

What if I need to see a specialist?
If you need to see a specialist, you can see any specialist without a referral; 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 (over $500) to find out how much you can expect to pay.

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. To find an Advantage Plus network specialist, use Find a Dentist.

Do I need to take a claim form when I visit the dentist?
If you visit an Advantage Plus 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.

What can a dentist bill me for?
United Concordia Advantage Plus network dentists accept our reimbursements, also known as maximum allowable charges (or MACs), as payment-in-full for covered services. United Concordia Advantage Plus 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?”
Limited access areas are geographic regions in which OPM has identified a smaller number of network dentists in proportion to the federal employee population. If you live in a limited access area and you receive covered services from an out-of-network dentist, United Concordia will pay for those services at the in-network coinsurance levels. Applicable plan maximums and other benefit features apply. You are also responsible for any difference between the amount the dentist bills and our allowable charge.

How do I find out if I live in a limited access area?
Please 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.

 

Back to Top  |   First Payor   |  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.

United Concordia coordinates benefits payments with:

  • Non-FEHB carriers - We coordinate benefit payments with any other group health benefits coverage you may have and payment of dental costs under no fault insurance that pays benefits without regards to fault.

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 policyholder for both FEDVIP and a commercial carrier, the plan which has been in effect the longest would be primary,

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.

 

Back to Top  |   First Payor   |  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.

Does United Concordia offer translation services?
Yes, United Concordia has 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.

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

 
Back