Skip to main content
 

Dental Plans

Dentist speaking with a patient during a dental exam.

 

Administrator: United Concordia Dental
Website:  www.ucci.com
Phone: 1-866-851-7564
Mobile App: HERE 

You may elect one of the dental options offered under the Plan or choose no coverage at all. This election is independent of your medical election. 

  Self Self +1 Family
UCCI Dental PPO (Traditional) $4.00 $8.92 $12.83
UCCI Dental DHMO $1.78 $3.37 $4.93
UCCI Dental Plan Comparison

IMPORTANT: Please note that if you are currently enrolled in a dental plan and “opt out” for the upcoming calendar year during Open Enrollment or if you do not elect dental coverage within 60 days from your hire date, you must satisfy a two-year waiting period to be eligible to re-enroll in a dental plan. 

The Traditional Dental Plan (Dental PPO) provides payment for the following covered services, subject to the plan maximums and limitations:

Class schedule: 

Class I Diagnostic and Preventive (no more than two in any calendar year). 100%  of reasonable and customary charges
Class II Basic Restorative, Endodontics, Periodontics, Maintenance of Prosthodontics and Oral Surgery 80%  of reasonable and customary charges
Class III Major Restorative, Installation of Prosthodontics 60%  of reasonable and customary charges
Class IV Orthodontics 60%  of reasonable and customary charges

The maximum benefit, excluding Class IV Services, is $2,000 per person each year. The lifetime maximum for Class IV Services (orthodontics) is $1,000 per person. Each year, you will need to meet a deductible of $50 per person, or $150 for family. The deductible does not apply to Class I Services. As an additional plan feature, if you use a dentist who is a member of the Preferred Provider Organization (PPO), charges for covered services will usually be discounted. This means your cost will usually be less than that associated with a dentist who is not a member of the PPO. Please remember that under the Traditional Dental Plan (Dental PPO), you may use any dentist you wish; use of the PPO feature is voluntary. You must submit any claims for services within fifteen (15) months following the date of service. 

 

The Dental HMO (DHMO) is an alternative option to the Traditional Dental Plan and operates much like a medical HMO. The key features of the plan include: No charge or modest patient charges for diagnostic/preventive and restorative procedures, as well as oral surgery,  fixed patient charges for services associated with crowns and bridges, endodontics, periodontics, prosthetics, denture relining and orthodontics (24 month maximum lifetime benefit for orthodontic services), the patient charge schedule applies only when procedures are performed by a network dentist; procedures performed by a non-network dentist are not covered,  only the procedures listed on the patient charge schedule for the Dental HMO (DHMO) will be covered; those procedures not listed will not be covered, and visits to a network specialist, such as an Endodontist, Periodontist, Orthodontist, Oral Surgeon, or Pediatric Dentist (up to the 7th birthday) require a signed specialty referral form from the patient’s primary dentist. 

UCCI Dental DHMO Fee Schedule

Go Top