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What are my dental benefits?
As a Johns Hopkins US Family Health Plan member, you have access to a DVN (Dental Value Network) which is a discounted, fee-for-service network. In addition, effective April 1, 2009, USFHP will now be paying for 2 routine dental cleanings per member per calendar year through United Concordia when you receive these services from a participating DVN provider.
What are the routine cleanings that are paid for by USFHP?
The routine cleanings that are covered are:
D1110 - adults (13 years and older)
D1120 - children (up to age 13)
How are the routine cleanings paid?
The dental provider will bill United Concordia directly for these services only; therefore, the USFHP member will have no out-of-pocket expense for these services.
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How are the other covered services paid?
Any other services listed on the Schedule of Charges will be paid by you according to the discounted rate. These rates are to be paid directly to the dental provider at the time of service.
What do the two columns on the Schedule of Charges represent?
The two columns represent the amount to be paid if the member sees a general dentist (GEN) or if the member sees a specialist (SPEC).
Can members be seen at more than one office?
Yes, members may receive benefits from any participating DVN provider.
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Do members need a referral to see a specialist?
No, members can go directly to participating DVN specialists.
Can a member go to a dentist who is not part of the DVN?
Yes, members visit an out-of-network dentist, but they will pay the dentist's normal charges, which can be higher than if they see a DVN provider. Note: Cleanings will not be covered by USFHP/United Concordia if a member is treated by an out-of-network provider.
Are the fees different for general dentists and specialists?
Yes, for some specialty procedures, the member will pay more to see a specialist. Please see the Schedule of Charges.
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What if a procedure is not listed on the Schedule of Charges?
If the procedure that a member receives is not listed on the Schedule of Charges, the member is responsible for the dentist's normal charge for that non-covered service.
Can the dentist charge more than the Schedule of Charges (i.e. "balance-bill")?
No, the dentist has contractually accepted the Schedule of Charges as his/her payment in full.
Are there any deductibles/copayments/monthly premiums specific to dental services?
No. The member is responsible for the entire payment for services listed on the Schedule of Charges at the time of service, with the exception of the 2 routine cleanings. There is no out-of-pocket expense for those 2 routine cleanings per year.
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Is the DVN national?
No, the DVN is primarily in MD, DC, Southern Pennsylvania and Northern Virginia.
What happens if a member resides in another area for a portion of the year and needs dental care?
The member would pay the dentist's normal charges, because he/she would be going to an out-of-network provider. In order to take advantage of the 2 paid cleanings and discounted rates on other covered services, the member must go to a participating DVN provider.
Will there be a separate dental membership card?
No. You will continue to present your US Family Health Plan card to the participating DVN provider, as you have been. They will be able to verify your eligibility through United Concordia's Customer Service.
Are there any Exclusions & Limitations?
Only the services listed on the Schedule of Charges are available at the discounted rate. Any service not listed on the Schedule of Charges is subject to the dental provider's normal charge.
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Who should a member call if they still have questions or need assistance?
Members may call United Concordia's Customer Service at 1-800-332-0366 or US Family Health Plan Customer Service at 410-424-4528 or 1-800-808-7347 for additional information.
How can a member find a participating provider or get more information on his/her dental benefits under this plan?
You can log on to the Johns Hopkins US Family Health Plan's Clients' Corner page on United Concordia's website at www.ucci.com/tuctcc/custom/jnshhc0020.jsp. To find a participating provider, simply click on the button in the middle of the page.
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