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DENTAL

DENTAL

United Concordia Dental Blue Edge Dental Flex | www.highmark.com

Blue Edge Dental Flex plan options provide you with maximum flexibility. Benefits are paid at the same level for care received from any provider. If you receive covered services from an out-of-network provider, the plan will apply the out-of-network standard percentages for covered services and you will be responsible for the difference, up to the provider’s charge.

With this plan:

  • Out-of-pocket costs are likely to be less when you choose an in-network dentist
  • Have 100% coverage for preventative services
  • Pay an annual deductible — $50 single / $150 family
  • 100% coverage for eligible basic services
  • Pay 50% of major covered services
  • Receive an annual maximum benefit —$2,000 / per person
  • Orthodontia is covered for children & adults. Receive 50% coverage to a lifetime maximum of $2,000.
  •  
  In-Network Out-of-Network
Office Visit Co-pay
(one office visit may cover multiple services)

None None
Preventive Care: 100% 100%
Bitewing X-Rays 100% 100%
Full Mouth X-Rays 100% 100%
Cleaning 100% 100%
Oral Exams 100% 100%
Sealants 100% 100%
Basic Care: 100% 100%
Fillings (one surface) 100% 100%
General Anesthesia1 100% 100%
Scaling & Root Planing
(per quadrant)
100% 100%
Simple Extractions 100% 100%
Major Care: 50% 50%
Dentures 50% 50%
Single Crowns 50% 50%
Orthodontia 50% 50%
Dental Rates
(Semi-Monthly Rates)
Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
Blue Edge Dental Flex $4.50 $8.50 $9.50 $15.00
NSM Insurance Group
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