$1,500 for children up to age 19, plus start up fees. $2,000 for adults plus start up fees. 2-year maximum length of treatment; additional usual and customary charges thereafter.
Filing a Claim
If you use a network dentist, the dentist’s office will usually file the claim for you. If you use a non-network dentist, you will usually need to file a claim yourself. Call CIGNA Dental at 1-800-244-6224 to request a form. You should submit your claim within 90 days from the date you receive service.
You will need to provide:
The date or dates the service was rendered;
The nature of the treatment plan and the type of service or supply furnished; and
The name, address, and signature of the dentist who provided the services.
Mail your completed claim form to the following address: United Concordia Dental Claims
PO Box 69421
Harrisburg, PA 17106-9421