Taking care of your dental benefits.
Effective through July 1, 2010
Overview
The Pennsylvania Builders Association Benefits Trust is proud to offer our
members who've signed up for Builders Benefits three dental options designed
to improve the quality, delivery and affordability of dental care.
The restorative plan provides coverage for
preventative and diagnostic services and some basic services. The Full plan
includes the services covered under the Basic program plus additional basic
services and coverage for major services and orthodontics. The Concordia Plus Plan is not available to new enrollees. Existing
groups enrolled in the Concordia Plus plan may make changes to their plan
by using the Dental/Vision Enrollment/Change Form.
To enroll in the Basic or Full dental options, at least 75% of all eligible
employees of the participating group must enroll in the plan option.
Provider network
Members can use the Provider
Network Directory provided by United Concordia, Inc. to search for participating
dentists.
Members in the Concordia Plus plan: choose the DHMO Concordia Plus network.
Members in either the Full or Basic Dental: choose the ParNet network.
Benefits
at a glance
Benefit
|
Basic
|
Full
|
Concordia Plus
|
Preventive Services
|
Diagnostic
|
100%
|
100%
|
100%
|
Preventive
|
100%
|
100%
|
100%
|
Basic Services
|
Basic Restorative
|
100%
|
100%
|
65%
|
Endodontics
|
100%
|
100%
|
65%1
|
Simple Extractions
|
100%
|
100%
|
65%1
|
Oral Surgery
|
N/A
|
100%
|
65%1
|
Non-Surgical Periodontics
|
N/A
|
50%
|
65%1
|
Surgical Periodontics
|
N/A
|
50%
|
65%1
|
Major Services
|
Crowns, Inlays, Onlays
|
N/A
|
50%
|
50%1
|
Fixed Prosthetics
|
N/A
|
50%
|
50%1
|
Removable Prosthetics
|
N/A
|
50%
|
50%1
|
Orthodontics
|
Coinsurance
|
N/A
|
50%
|
N/A
|
Lifetime Maximum per child
|
N/A
|
$800
|
N/A
|
Other
|
Program Calendar Year Deductible
|
None
|
None
|
None
|
Program Calendar Year Maximum per person
|
$1,000
|
$1,000
|
None
|
1 Please note that all covered services are eligible only when
provided by the Primary Dentist within the Concordia Plus Primary Dental
Office. Services provided by any one other than the Primary Dentist within
the Primary Dental Office are not covered under this program.
Monthly Rates
All rates are effective July 1, 2009 through June 30, 20010.
All Central, Northeast, and Southest
PA Counties *
|
Monthly Rates
|
Basic
|
Full
|
Concordia Plus
|
Single
|
$20.26 |
$29.38 |
$18.16 |
2 Person
|
$57.16 |
$80.59 |
$33.26 |
Family
|
$57.16 |
$80.59 |
$47.67 |
*Includes Adams, Berks, Bradford, Bucks, Carbon,
Centre (part), Chester, Clinton, Columbia, Cumberland, Dauphin, Franklin,
Fulton, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, Mifflin,
Monroe, Montgomery, Northampton, Northumberland, Perry, Philadelphia, Pike,
Schuylkill, Snyder, Sullivan, Susquehanna, Union, Wayne and Wyoming Counties.
All Allegheny Region Counties *
|
Monthly Rates
|
Basic
|
Full |
Concordia Plus
|
Single
|
$24.85 |
$34.06 |
$18.16 |
2 Person
|
$70.52 |
$94.33 |
$33.26 |
Family
|
$70.52 |
$94.33 |
$47.67 |
*Includes Allegheny, Armstrong, Beaver, Butler, Bedford, Blair, Cambria, Cameron, Centre (Part), Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Huntingdon, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Somerset, Warren, Washington and Westmoreland Counties.
If you have any further questions, please contact
us; we'll be glad to help you
|
