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New Participant Portal
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Register for New Participant PortalRetiree Health Summary Plan Description
As of January 1, 2026
6.2 Comparison of Dental Benefits
This summary of the benefits, exclusions, limitations, and other provisions affecting dental benefits is not intended to take the place of the respective Evidence of Coverage document or Schedule of Benefits. Please refer to your Evidence of Coverage and Disclosure Document for a complete description of your dental benefits, including the exclusions and limitations. In the event of any conflict between the information summarized in this section and the Certificate of Insurance document or Schedule of Benefits, the Certificate of Insurance document or Schedule of Benefits shall govern.
| Dental Provider Name | United Concordia | DeltaCare | United Concordia |
|---|---|---|---|
| Plan Type | PPO | DHMO | DHMO |
| Member Customer Service | (866) 332-0366 | (800) 422-4234 | (866) 357-3304 |
| Website Address | unitedconcordia.com | deltadentalins.com | unitedconcordia.com |
Claims Filing Address Applies to PPO plan only |
P.O. Box 69421 Harrisburg, PA 17106 |
||
| Description | MEMBER CO-PAYMENT | ||
| Network | In-Network Out-of-Network |
In-Network Only | In-Network Only |
| Annual deductible | |||
| Per individual | $0/$25 | N/A | N/A |
| Per family | $0/$75 | N/A | N/A |
Annual Maximum Waived for diagnostic and preventive |
|||
| Per individual | $5,000 | N/A | N/A |
| Per family | N/A | N/A | N/A |
Diagnostic/Preventive X-rays, exams, cleanings |
0%/0%, plus balance billing | $0 | $0 |
Basic Fillings, sealants, oral surgery, root canals |
5%/20% plus balance billing | $0 (for white fillings) | $0 - $140 (for white fillings) |
Major Crowns and casts, dentures, bridges and implants |
25%/50% plus balance billing Implants only: 25%/25% plus balance billing |
$0 (no added metal fees) (Implants not covered) | $0 (for metal crowns and bridges) In-Network Dentists can charge an additional $125 for the use of precious (high noble) or semi precious (noble) metal. Implants are not covered. |
Emergency Services Emergency exam |
0%/0% plus balance billing | $0 | $0 |