Network: Advantage Plus

Network: Advantage Plus

Dental Benefits Summary for University of Pittsburgh Retiree

Network: Advantage Plus

Benefit Category / Access Plan
In-Network1 / Non-Network1
Class I – Diagnostic/Preventive Services
Exams / 100% / 100%
Bitewing X-rays
Cleanings & Fluoride Treatments
Sealants
Class II – Basic Services
All Other X-rays / 70% / 70%
Basic Restorative (Fillings)
Simple Extractions
Space Maintainers
Repairs of Crowns, Inlays, Onlays, Bridges, and Dentures
Palliative (Emergency) Treatment
Class III – Major Services
Endodontics /
Member pays reduced
discounted fee2 /
Member pays
dentist’s full charge
Nonsurgical Periodontics
Surgical Periodontics
Complex Oral Surgery
General Anesthesia
Inlays, Onlays, Crowns
Prosthetics (Bridges, Dentures)
Orthodontics (Adults and Dependents)
Diagnostic, Active, Retention Treatment / Member pays reduced
discounted fee3 / Member pays
dentist’s full charge
Maximums & Deductibles (cumulative of network and non-network)
Annual Program Deductible (per person/per family) / $25/$75
Class I and
Class II Services / $25/$75
Class I and
Class II Services
Annual Program Maximum (per person) (January-December) / $750 / $750

Representative listing of covered services – certificate of coverage provides a detailed description of benefits.

1.  Reimbursement is based on our schedule of maximum allowable charges (MACs). Network dentists agree to accept our allowances as payment in full for covered services (less any coinsurance amounts that are the member’s responsibility). Non-network dentists may bill the member for any difference between our allowance and their fee. United Concordia Dental’s standard exclusions and limitations apply.

2.  Receive non-covered services at a discount when visiting an Advantage Plus network dentist. To search for a dentist use the Find a Dentist tool on United Concordia com Select Advantage Plus network and look for dentists who have a black box (n) next to their name. Even though our entire network of dentists accepts United Concordia s allowances for services that are covered each dentist with a black box (n) next to their name accepts our allowances for non-covered services as well including services that go over the annual maximum Non covered services are services in which no benefit payments including alternate benefit payments are made by United Concordia

Discount levels may vary by procedure and geographic area