Active Health Plan Benefit Tabs™

This is a summary of benefits and not a substitute for the Southern California IBEW-NECA Health Plan Summary Plan Description, and to the extent it differs from the SPD, the terms of the SPD will govern.

Dental Plans
 
Overview
 

The United Concordia Dental Plan (PPO) offers coverage at affordable rates and access to a large dental network. You can maximize your benefits by visiting a Concordia Advantage Plus Network dentist.

United Concordia PPO Dental Plan encourages in-network utilization and offers members' discounts for in-network services, already negotiated with network dentists, versus services received out-of-network. Using a Concordia Advantage Plus network dentist can maximize your benefit dollars because you save the difference between negotiated fees and the dentist's regular charges. You will receive more services before reaching the annual maximum. That means you save money by visiting a network dentist.

The benefits may differ and out-of-pocket costs could be higher with a non-network dentist. A non-network dentist can charge you for applicable deductibles and coinsurance amounts, and the difference between their standard charges and United Concordia's allowances.

Sample Benefits
 
Benefits
In-Network
Out-of-Network

Diagnostic/Preventive
(X-rays, Exams, Cleanings)

100%

100%

Basic (Fillings, Sealants, Oral Surgery, Root Canals)

95%

80%

Major (Crowns & Casts, Dentures, Bridges, Implants)

75%

50%

Orthodontics - Child

50%

50%

Lifetime Ortho Max

$1,400

$1,400

Summary of Benefits

Annual Maximum
 

In-Network: $5,000 per patient per calender year.
Out-of-Network: $5,000 per patient per calender year.

Orthodontics
 

The UCCI PPO Plan will pay up to 50% of the cost of scheduled orthodontic treatment, up to a lifetime maximum benefit of $1,400 for each dependent child. There are no orthodontic benefits for adults. Orthodontic benefits are in addition to other dental benefits payable under the UCCI PPO Plan.

Predetermination/
Preauthorization
 

Determine costs ahead of time by asking your dentist to submit the treatment plan to UCCI for a free pre-treatment estimate before any treatment is provided. UCCI will verify your specific plan coverage and the cost of the treatment and provide an estimate of your copayment/coinsurance and what UCCI will pay. Remember that you and your dentist should make decisions about your treatment plan based on your dental needs and not necessarily on the reimbursement by your dental plan.

Additional Information
 

UCCI PPO
Phone Number: 1-800-332-0366