Dental Preferred Provider Organization (DPPO) Plan
|How the United Concordia DPPO Plan Works|
|Members may utilize participating and/or nonparticipating dentists.|
|There is a deductible of $50 per person/$150 per family January 1, 2014 — December 31, 2014, excluding Class I — Diagnostic and Preventive Services and Class IV — Orthodontic Services|
|The Smile for Health® Maternity Dental Benefit provides women with additional dental cleaning during pregnancy. This extra cleaning can help control pregnancy gingivitis and help prevent periodontal (gum) disease, which has been linked to premature and low-birthweight babies.|
|There is a maximum benefit of $1,500 per member per contract year (January 1st, 2014 - December 31st, 2014) for services received under the DPPO plan. Your plan includes the Preventive Incentive® feature, in which covered Class I services do not count toward the maximum benefit.|
|When care is received from a United Concordia Advantage Plus network dentist, there are no claim forms to submit and you are only responsible for coinsurance amounts and applicable deductibles. If you receive services from a nonparticipating dentist, claims forms must be submitted and you are subject to balance billing. |
|You do not need a referral to receive care from a specialist. |
| Orthodontic benefits are available for dependent children through age 26. The orthodontia lifetime maximum is $2,000. Orthodontic services are available from participating and nonparticipating dentists. |
|You must select the DPPO plan if you reside outside of the Maryland service area (DC, DE, MD, PA, VA , WV). The DHMO plan option is only available to those residing in the Maryland service area.|
DPPO Network of Dentists
To receive in-network benefits, members must receive services from a dentist who participates in the Concordia's Advantage Plus network. You always have the option of receiving care from non-network dentists under the DPPO plan. To search for a Concordia Advantage Plus network dentist, click here, or call 1-888-638-3384.
Financial Responsibility of Plan Member
Deductibles and coinsurance are the responsibility of the plan member. Before you receive any services, be sure to review the plan design for your dental plan to ensure that you have anticipated all out-of-pocket costs and liabilities associated with a particular treatment. If your dental treatment is estimated to cost $500 or more, you may want to ask your dentist to request a predetermination of benefits. You are encouraged to discuss major procedures and your financial liability with your dentist. You may also contact United Concordia's Customer Service Department to determine your financial responsibility. If calling Customer Service, please have the ADA procedure code, dentist's name and dentist's charge available (you can get this information from your dentist).