Plan: GEHA Connection Dental Rider

Type:

PPO with specific co-pay fee schedules

Open Dental Insurance Setup:

• Carrier: GHEA Connection Dental, (877) 434-2336, PO Box 4665, Independence, MO 64051-2336
• Group:
• Plan Type: PPO Percentage
• Don't Substitute: check the box - co-pay setup
• Fee Schedule: Connection Dental
• Other Fee Schedules: GEHA Dental Rider High or Standard Co-pay
• Benefit Information: put 100% in all categories

Plan Notes:

• Has a different PO box then other plan subtypes.
• This is a dental “rider” that is a break off of the patients’ medical plan.  
• The card with have ‘UHC’ on it and will look like a medical insurance card.
• Look for ‘High’ or ‘Standard’ on the card
• This is typically billed as the primary insurance
• Very limited plan!  Only preventative and certain codes are covered.
• Only difference between high and standard is preventative.
• Pt responsible for difference between Connection Fee Schedule and what insurance doesn't cover.

Coverage:

Category
Preventative (Standard/High)	50%/$22
D7140, D7210(Basic ext)	$21
D2391 (1 surf)	$21
D2392, D2393, D2394 (2+ suf)	$28

Sample Cards: