Understanding your FEDVIP Dental Benefits

Understanding Alternate Benefit Provision

The Alternate Benefit Provision helps determine how payment will be made for a covered procedure when there are two or more clinically-acceptable dental services available to satisfactorily correct the same dental condition. This provision states that United Concordia will provide coverage for the less expensive treatment available (member coinsurance may apply), while still ensuring you receive the quality care needed for a healthy smile. Should you and your dentist choose the more expensive treatment, you are responsible for the additional charges beyond the allowance for the alternate service, even if using an in-network provider.

Example 1: If you need a filling for a back molar, you pay the copayment, and United Concordia pays the remainder – up to the allowance for the amalgam (silver-colored) filling. If you and your dentist choose to use a composite resin (tooth-colored) filling, the program covers up to the allowance for the amalgam filling, which is the alternate benefit. You also would be responsible for paying your dentist the difference in cost between the amalgam and composite resin fillings.

Example 2: A cracked tooth can often be repaired using a four-surface filling; however, if you and your dentist decide to use a crown instead, the plan pays the allowance for the four-surface filling and you are responsible for paying the difference in cost for the crown.

It's important to discuss all of your options with your dentist prior to treatment. If a proposed treatment plan is estimated to cost $500 or more, United Concordia encourages you to ask for a predetermination. Your dentist will submit the information to United Concordia and you will receive an estimated breakdown to determine if the service is covered and how much the plan covers and how much you will have to pay, helping you make the most of your dental plan.

Other Benefits Briefs
Understanding Coverage for Fillings
Understanding Coordination of Benefits
About United Concordia's Network

We also have a library of Dental Health 101 articles for you and your employees' information. Please feel free to use these in your publications/communications as well.


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