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Ype of Activity change(s) in Section A along with the identification number and employee name in Section B and Section C for dependent changes. Effective Date (mm/dd/yyyy) SECTION A: GENERAL INFORMATION 1. TYPE OF PROGRAM SECTION E: FOR EMPLOYER USE ONLY EMPLOYER INFORMATION 2. TYPE OF ACTIVITY FFS (Indemnity, Passive PPO - Please Specify) Concordia Access Concordia Choice Concordia Flex Concordia Select Other DHMO (Please Specify) Concordia Plus Other New Enrollment Cancel Coverage Canc.

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Contact support

We're proud to serve those who serve the nation, from active duty military personnel and their families worldwide, to federal employees and military retirees.

If you'd like to speak with a United Concordia Representative, please give us a call: Call United Concordia: CONUS Toll Free: 844-653-4061.

To meet this requirement, the person receiving the services must be continuously enrolled in this Plan for the entire waiting period of 12 months. Waiting period may be waived if you submit proof of prior orthodontic coverage in 2021.

Request a Payor Payor IDPayor NameCX013United Concordia- Dental PlusCX013Concordia Dental PlusCX013UCCI National Plus

Providing dental coverage to the military and federal employee communities for over 20 years.

The Identification number/SSN is the same for all members on the contract. If you do not know the identification number, use the social security number of the policy holder and your date of birth.

United Concordia will refund 50% of an average monthly dental premium payment. Refunds will be in the form of a check and issued in August*. United Concordia is required to notify recipients prior to issuing actual refunds.

United Concordia will reimburse you for the claim, less the amount you paid for your cost-share. United Concordia will pay a nonparticipating dentist directly only if you designate on the claim form that the dentist is to receive the payment.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232