Representatives will be unavailable on Monday, May 25, for the Memorial Day holiday.
Member and Provider Services Representatives Unavailable Monday, May 25
Member and Provider Services Representatives Unavailable Monday, May 25
Representatives will be unavailable on Monday, May 25, for the Memorial Day holiday.
Employer Contribution: To qualify for group dental plan, the employer must contribute a minimum of 50% toward the individual contract premium payment.
For further details on the coverage, including exclusions, any reductions or limitations and the terms under which the benefit plan may be continued, see your account executive. United Concordia Companies, Inc. is an independent company providing dental benefit administration services and access to provider network for the Blue Cross Blue Shield of North Dakota dental products.
D(P) = Participating Dentist
D(NP) = Nonparticipating Dentist
1Covered service does not apply to benefit maximums
2Deductible des not apply
| Employee-Paid | Preferred | Preferred+ |
|---|---|---|
| Available to groups of 10 employees or more |  |
|
| Deductibles | ||
| Member Family |
D(P)$50 | D(NP) $100 D(P) $100 | D(NP) $200 |
D(P)$50 | D(NP) $100 D(P) $100 | D(NP) $200 |
| Annual Maximums | ||
| Member Family |
D(P)$1,000 | D(NP) $1,000 D(P) $1,500 | D(NP) $1,500 |
D(P)$1,000 | D(NP) $1,000 D(P) $1,500 | D(NP) $1,500 |
| Orthodontic Lifetime Maximums | ||
| Member Family |
Not covered | D(P)$1,500 | D(NP) $1,500 D(P) $2,000 | D(NP) $2,000 |
| Services | ||
| Diagnostic | ||
| Exam1 | D(P) 100%2 | D(NP) 80% | D(P) 100%2 | D(NP) 80% |
| Radiographs | ||
| Bitewing X-rays Full Mouth/Panoramic X-rays Occlusal Films |
D(P) 100%2 | D(NP) 80% | D(P) 100%2 | D(NP) 80% |
| Preventive | ||
| Cleanings (Prophylaxis)1 Fluoride1 |
D(P) 100%2 | D(NP) 80% | D(P) 100%2 | D(NP) 80% |
|
Sealants Space Maintainers |
D(P) 80% | D(NP) 60% | D(P) 80% | D(NP) 60% |
| Restorative | ||
| Amalgam Restorations Fillings |
D(P) 80% | D(NP) 60% | D(P) 80% | D(NP) 60% |
|
Crowns and Repairs Inlays, Onlays and Repairs |
D(P) 60% | D(NP) 50% | D(P) 60% | D(NP) 50% |
| Endodontic | ||
|
Endodontic Therapy Root Canal Retreatment Apioectomy/Periradicular |
D(P) 80% | D(NP) 60% | D(P) 80% | D(NP) 60% |
| Periodontal | ||
|
Surgical/Nonsurgical Periodontics Root Canal Retreatment |
D(P) 80% | D(NP) 60% | D(P) 80% | D(NP) 60% |
| Prosthodontic | ||
|
Removable Complete/Partial Dentures Fixed Partial Dentures (Bridges) Adjustments/Repairs of Dentures |
D(P) 60% | D(NP) 50% | D(P) 60% | D(NP) 50% |
| Implant | ||
| Surgical Placement Supporting Structures Treatment of Implant Defects |
D(P) 50% | D(NP) 50% | D(P) 50% | D(NP) 50% |
| Fixed Partial/Removable Denture | D(P) 60% | D(NP) 50% | D(P) 60% | D(NP) 50% |
| Cone-Beam CT Images | D(P) 100%2 | D(NP) 80% | D(P) 100%2 | D(NP) 80% |
| Removal of Teeth | ||
| Simple and Surgical Extractions | D(P) 80% | D(NP) 60% | D(P) 80% | D(NP) 60% |
| Complex Oral Surgery | D(P) 60% | D(NP) 50% | D(P) 60% | D(NP) 50% |
| Adjunctive General | ||
| Consultations General Anesthesia, Nitrous Oxide, IV Sedation |
D(P) 80% | D(NP) 60% | D(P) 80% | D(NP) 60% |
| Palliative Treatment (Emergency) | D(P) 100%2 | D(NP) 80% | D(P) 100%2 | D(NP) 80% |
| Orthodontic | ||
| Orthodontic Services | Not covered | D(P) 50%2 | D(NP) 50% |
Employee-Paid BlueDental Preferred: Voluntary dental program options are available to groups of ten or more enrollees or 20% participation (whichever is greater), and are 100% employee-paid
Employee-Paid BlueDental Preferred+: Voluntary dental program with orthodontia coverage are available to groups of ten or more enrollees or 20% participation (whichever is greater), and are 100% employee-paid. Dental plans with orthodontia require a 24-month waiting period without prior orthodontic coverage
For further details on the coverage, including exclusions, any reductions or limitations and the terms under which the benefit plan may be continued, see your account executive. United Concordia Companies, Inc. is an independent company providing dental benefit administration services and access to provider network for the Blue Cross Blue Shield of North Dakota dental products.
D(P) = Participating Dentist
D(NP) = Nonparticipating Dentist
1Covered service does not apply to benefit maximums
2Deductible des not apply
