United Concordia Clients Corner Johns Hopkins Medicine - US Family Health Plan
Frequently Asked Questions

What are my dental benefits?

As a Johns Hopkins US Family Health Plan member, you have access to the Concorida Advantage Ammended network, a seamless national network of providers with over 129,500 unique access points across the country. In addition, USFHP will now be paying for 2 routine dental cleanings per member per calendar year through United Concordia when you receive these services from a participating Advantage Amended provider.

What are the routine cleanings that are paid for by USFHP?

The routine cleanings that are covered are:

D1110 - adults (13 years and older)

D1120 - children (up to age 13)

How are the routine cleanings paid?

The dental provider will bill United Concordia directly for these services only; therefore, the USFHP member will have no out-of-pocket expense for these services.

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How are the other covered services paid?

Any other services listed on the Fee Schedule according to the discounted fees. These fees are to be paid directly to the dental provider at the time of service.

What do the two columns on the Fee Schedule represent?

The two columns represent the minimum and maximum a member should expect to pay for covered discounted services. These fees may vary by region and provider, and are subject to periodic changes.

Can members be seen at more than one office?

Yes, members may receive benefits from any participating Concordia Advantage Amended provider.

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Do members need a referral to see a specialist?

No, members can go directly to participating Concordia Advantage Amended specialists.

Can a member go to a dentist who is not part of the Concordia Advantage Amended network?

Yes, members visit an out-of-network dentist, but they will pay the dentist's normal charges, which can be higher than if they see a Concordia Advantage Amended

Are the fees different for general dentists and specialists?

Yes, for some specialty procedures, the member will pay more to see a specialist. Please see the Fee Schedule.

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What if a procedure is not listed on the Fee Schedule?

If the procedure that a member receives is not listed on the Fee Schedule, the member is responsible for the dentist's normal charge for that non-covered service.

Can the dentist charge more than the Fee Schedule (i.e. "balance-bill")?

No, the dentist has contractually accepted the Schedule of Charges as his/her payment in full.

Are there any deductibles/copayments/monthly premiums specific to dental services?

No. The member is responsible for the entire payment for services listed on the Fee Schedule at the time of service, with the exception of the 2 routine cleanings. There is no out-of-pocket expense for those 2 routine cleanings per year.

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Is the Concordia Advantage Amended network national?

Yes. The Concordia Advantage Amended network is a national network with over 57,000 participating providers and over 129,500 unique access points nationwide.

What happens if a member resides in another area for a portion of the year and needs dental care?

Utilizing the Concordia Advantage Amended network members should have access to participating providers in most areas across the country. Should a member have to utilize an out-of-network provider, then the member would pay the dentist's normal charges. In order to take advantage of the 2 paid cleanings and discounted rates on other covered services, the member must go to a participating Concordia Advantage Amended provider.

Will there be a separate dental membership card?

No. You will continue to present your US Family Health Plan card to the participating Concordia Advantage Amended provider, as you have been. They will be able to verify your eligibility through United Concordia's Customer Service.

Are there any Exclusions & Limitations?

Only the services listed on the Fee Schedule are available at the discounted rate. Any service not listed on the Fee Schedule is subject to the dental provider's normal charge.

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Who should a member call if they still have questions or need assistance?

Members may call United Concordia's Customer Service at 1-800-332-0366 or US Family Health Plan Customer Service at 410-424-4528 or 1-800-808-7347 for additional information.

How can a member find a participating provider or get more information on his/her dental benefits under this plan?

You can log on to the Johns Hopkins US Family Health Plan's Clients' Corner page on United Concordia's website at www.ucci.com/tuctcc/custom/jnshhc0020.jsp. To find a participating provider, simply click on the button in the middle of the page. *Remember to always choose a provider with a BLACK BOX(■) by their name in order for services to be covered.

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