2024-UATP-Benefits Guide

DENTAL

LOCATE A UCCI DENTAL PROVIDER Visit www.unitedconcordia.com to find a dentist near you.

PPO PLAN (ELITE PLUS)

BENEFIT

IN-NETWORK

OUT-OF-NETWORK

Individual: $50 Family: $150

Individual: $50 Family: $150

Annual Deductible

$2,000

$2,000

Calendar Year Maximum

Covered 100%

Covered 100%

Preventive Services

Covered 90%*

Covered 80%*

Basic Services

Covered 60%*

Covered 50%*

Major Services

Covered 60%*

Covered 60%*

Implants

50%

50%

Orthodontic Coinsurance

$1,500

$1,500

Lifetime Orthodontic Maximum

*After deductible

VISION

LOCATE A VSP PROVIDER The VSP Choice Plan is a premier full - service plan that offers choice, flexibility, and maximum value through a VSP preferred provider. For a list of preferred providers, visit www.vsp.com, select “ find a doctor ” and search the choice network.

CHOICE PLAN

BENEFIT

IN-NETWORK

OUT-OF-NETWORK

$10 copay

Exam (once every 12 months)

Up to $45 reimbursement

Frames (once every 24 months)

$130 frame allowance 20% off remaining balance

Up to $70 reimbursement

Lenses (once every 12 months) Single Vision

$10 copay $10 copay $10 copay $10 copay Covered in full after copay $130 allowance

Up to $30 reimbursement Up to $50 reimbursement Up to $65 reimbursement Up to $100 reimbursement Up to $210 reimbursement Up to $105 reimbursement

Bifocal Trifocal Lenticular

Necessary Contacts in lieu of Eye Glasses Elective Contacts in lieu of Eye Glasses

DENTAL AND VISION BENEFITS | UATP

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