At UPMC Health Plan, we have a long history of providing members with high-quality benefit plans, provider networks, and unparalleled customer service. The tradition continues with UPMC Dental Advantage. UPMC Dental Advantage offers employees three options — Basic, Standard, and Premium — with a network of fully credentialed dentists. The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans.
- You will receive outstanding customer service from UPMC Health Plan's Health Care Concierge team. They are able to answer questions about your medical and dental benefits (if applicable) — both at the same phone number.
- Our Basic, Standard, and Premium options are dental PPO plans, so you do not need to select a primary dentist from our network of fully credentialed dentists.
- There is no waiting period and you can't be denied coverage or benefits if you have a pre-existing dental condition.
- UPMC Dental Advantage does not require prior authorization for major services.
- No ID card is required. You will provide your dentist's office with some basic demographic information and the name of your employer.
- You have access to your dental, medical, MyFlex Advantage (if applicable) information, and health tools through MyHealth OnLine.
- One additional cleaning for members who are pregnant, during the course of pregnancy.
- Increased coverage for non-surgical periodontal treatment, including the topical application of fluoride, for adults with a history of surgical periodontal treatment.
- Coverage for microbial tests and brush biopsies.
- All Class I Diagnostic and Preventive services, such as cleanings, exams, and x-rays, do not count toward your benefit limit, which leaves more of your benefit dollars for other covered dental procedures.
UPMC Dental Advantage encourages, but does not require, members to seek predetermination for major services, such as crowns and bridges. A predetermination gives you and your dentist an advance estimate of your benefit and how much of the cost may be your responsibility. Providers may submit predeterminations electronically, so the response may only take a few business days.
Continuity of Benefits
If you select UPMC Dental Advantage and you or a family member are undergoing orthodontia or other dental treatment on the effective date of your UPMC Dental Advantage coverage, this is how your benefits will be transitioned:
- Fixed bridgework, crowns, inlays, and onlays are covered by UPMC Dental Advantage only if initiation of treatment and preparation of teeth and placement of teeth occurs after the patient is covered. Otherwise, your prior dental carrier is responsible for the claim.
- UPMC Dental Advantage reimburses endodontic work based on completed date of service, so if the work is completed prior to the effective date of your UPMC Dental Advantage coverage, the prior dental carrier is responsible for the claim. Otherwise, the claim will be covered by UPMC Dental Advantage.
- UPMC Dental Advantage distributes the lifetime orthodontia benefit throughout the course of the treatment for eligible members. The payment schedule is determined based on the banding date and the estimated length of treatment. If your orthodontic treatment is already in progress on the effective date of your UPMC Dental Advantage coverage, your orthodontist will still receive the remainder of your maximum lifetime benefit from the UPMC Dental Advantage plan. You will not lose benefits by switching dental plans that have the same lifetime orthodontic maximum benefit.