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| December 4, 2008 |
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Concordia PLUS Dental HMO

Coverage
Following is a summary of the coverage level, terms
and conditions for the Concordia PLUS Dental HMO offered by the Council's Employee Benefits Group.
Concordia PLUS Dental HMO consists of a limited network of dental providers and a primary Dental Office must be chosen.
Benefits at a Glance
| DentalPLUS® |
| Diagnostic |
100% |
| Preventive |
100% |
| Basic Restorative |
100% |
| Endodontics |
100% |
| Simple Extractions |
100% |
| Oral Surgery |
N/C |
| Non-Surgical Periodontics |
25% |
| Surgical Periodontics |
N/C |
| Crowns, Inlays, Onlays |
25% |
| Fixed Prosthetics |
25% |
| Removable Prosthetics |
25% |
| Orthodontics |
N/C |
| Program Calendar Year Deductible: |
None |
| Program Calendar Year Maximum: |
$1,200 |
Payment of benefits is based on the Usual, Customary, and Reasonable (UCR) charges as determined by Highmark Blue Cross Blue
Shield. This description outlines the principal features of the dental programs offered by the Council's Employee Benefits Group. It is not to be considered the contract of benefits and provisions. The complete terms of coverage are set forth in agreements issued by the individual carriers.
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Provider Network
Members can use the Provider Network Directory provided by United Concordia, Inc. and select "Penn Dental" to search for participating dentists in your area.
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If you have any further questions, please contact us; we'll be glad to help you.
This information is not intended for use without professional advice. While we have attempted to make this site as accurate as possible, it is only a summary. For more information, see our disclaimer.  Last updated on: Wednesday, December 07, 2005 Page:
Copyright © 2003 Pittsburgh Technology Council. All Rights Reserved.
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