Unitedconcordia docsinddisableddisabled dependent certification form - United Concordia: Fill out & sign online

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Click ‘Get Form’ to open the Disabled Dependent Certification in the editor.
Begin by completing all applicable sections, starting with Section 1 for Subscriber Information. Fill in your full name, Subscriber ID, Group number, address, and telephone number.
Proceed to Section 2 for Dependent Information. Enter the full name of the disabled dependent, their marital status, sex, date of birth, relationship to you, and nature of disability.
In this section, indicate if the dependent has other health insurance. If yes, provide the necessary details including Health Insurance ID Number and Customer Service Number.
Complete any required documentation such as SSDI Award Letter or Court Order as specified. Ensure that both you and the licensed physician sign where indicated.
Finally, review all entries for accuracy before sending the completed form to LifeWise at the provided address.

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Is United Concordia the same as Tricare dental?

How do I join the United Concordia Dental Network? To join our network, contact our customer service department to obtain the appropriate network enrollment paperwork at 1-800-307-8514. You will need to provide your full name, contact information, and desired networks.

How much does United Concordia pay for dental implants?

2024 Plan Benefits Summary 2025 Plan Year - Covered Dental ServicesUnited Concordia Dental Pays2 High Option Plan Dental Implant Services Annual Maximum (per covered person) $2,500 $2,500 Lifetime Orthodontic Maximum (per covered person) $3,000 $3,000 Dental Accident Lifetime Maximum (per covered person) $2,000 $2,00033 more rows

Is United Concordia the same as Blue Cross Blue Shield?

United Concordia is an independent company that administers dental benefits on behalf of Blue Cross and Blue Shield of Louisiana members.

What is another name for Blue Cross Blue Shield?

BCBS Companies STATE/TERRITORYAVAILABLE COMPANIES California Anthem Blue Cross Blue Shield of California Colorado Anthem Blue Cross and Blue Shield Colorado Connecticut Anthem Blue Cross and Blue Shield Connecticut Delaware Highmark Blue Cross Blue Shield Delaware48 more rows