Taking care of your dental benefits.
Effective through June 30, 2011
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.
To enroll in a PBA Benefits Trust dental plan, at least 75% of all eligible employees of the participating group must enroll.
All plan benefits and rates are effective through June 30, 2011, regardless of a group’s effective date of coverage.
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
|
$50/$1502
|
$50/$1502
|
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.
2Calendar Year Deductibles are effective July 1, 2010.
Monthly Rates
All rates are effective July 1, 2010 through June 30, 2011. If you are interested in enrolling for a June 1, 2010 effective date, please contact our Customer Service Center at 888-221-2550 for rates.
All Central, Northeast, and Southest
PA Counties *
|
Monthly Rates
|
Basic
|
Full
|
Concordia Plus
|
Single
|
$21.76 |
$30.88 |
$19.66 |
2 Person
|
$60.16 |
$83.59 |
$36.26 |
Family
|
$60.16 |
$83.59 |
$50.67 |
*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 Western PA Region Counties *
|
Monthly Rates
|
Basic
|
Full |
Concordia Plus
|
Single
|
$26.35 |
$35.56 |
$19.66 |
2 Person
|
$73.52 |
$97.33 |
$36.26 |
Family
|
$73.52 |
$97.33 |
$50.67 |
*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
|
