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FDCi Membership Services & Benefits

OHP Benefits ‐ Quick Reference Guide

Dental Covered and Non‐Covered Services Chart & More

FDCi 2018 Member Handbook

ServicesPregnant Women & under 2121 & Over who are Not Pregnant
Exams2 Every 12 mo.*1 every 12 mo.
Cleanings2 Every 12 mo.*1 every 12 mo.
Flouride2 Every 12 mo.*1 every 12 mo.
Emergency ExamYesYes
FillingsYesYes
Root CanalPA Required**PA Required***
Retreat Root CanalPA Required--anterior onlyPA Required--anterior only
CrownsPA RequiredPA Required
DenturesPA RequiredPA Required
ExtractionsYesYes
Wisdom TeethPA RequiredPA Required

PA = Prior Authorization

* For children 18-years of age and under.

** Wisdom teeth, and 2nd molar for pregnant women, not covered.

*** Wisdom teeth and molars not covered.

Your FDCi OHP dental plan is a managed care plan. You may choose any clinic or dental office in the FDCi network as your primary care dentist (PCD). Your PCD will work with you to take care of your dental needs. Call your PCD before seeking dental care. See the provider directory or call FDCi Customer Service for your PCD’s phone number.

Your PCD will:

  • Provide all of your routine and primary dental care;

  • Arrange for specialty care when needed;

  • Write prescriptions (only for dental needs);

  • Keep your dental records; and

  • Submit request for Prior‐Authorizations and Referrals.

Ride To Care

Ride to Care

Your OHP membership includes medical transportation options provided by Ride To Care. Please contact your medical or dental plan for more information.

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Passport To Languages

Passport To Languages

Your FDCi membership also includes Passport To Languages translation services. Call them to schedule a translator in your native language for your next dental appointment.

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