| Hoss's Steak and Sea House Concordia Flex Benefits |
| Diagnostic & Preventive |
Level of Coverage*
|
| Exams |
100%
|
| X-Rays (periapical, bitewing and full-mouth) |
100%
|
| Cleanings (cleaning, scaling and polishing) |
100%
|
| Fluoride Treatments (dependent children <19) |
100%
|
| Sealants (dependent children-limits apply based on "tooth") |
100%
|
| Basic Services | |
| Basic Restorative (silver amalgam-posterior
teeth and synthetic tooth color-anterior teeth) |
50%
|
| Endodontics (includes pulpotomy and root canal treatment) |
50%
|
| Non-surgical Periodontics |
Not Covered
|
| Surgical Periodontics |
Not Covered
|
| Simple Extractions |
100%
|
| Complex Oral Surgery |
Not Covered
|
| Major Services | |
| Inlays, Onlays, Crowns |
25%
|
| Prosthetics |
Not Covered
|
| Maximums and Deductibles | |
| Annual program maximum (Per Individual) |
$500
|
| Deductibles |
None
|
* This percentage is based upon United Concordia's Maximum Allowable Charge (MAC). Participating providers will accept United Concordia's allowance as payment in full (less any deductible or coinsurance amounts that are the member's responsibility). The network of participating providing providers for this program is Concordia Advantage. To verify that your provider participates with Concordia Advantage,
please visit the web site at www.unitedconcordia.com
or contact our Dental Customer Service department at United Concordia's standard exclusions and limitations will apply. |
|