FDCi Membership Services & Benefits

OHP Benefits ‐ Quick Reference Guide

Dental Covered and Non‐Covered Services Chart & More

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Welcome Letter to Members

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Services Pregnant Women & under 21 21 & Over who are Not Pregnant
Exams 2 Every 12 mo.* 1 every 12 mo.
Cleanings 2 Every 12 mo.* 1 every 12 mo.
Fluoride 2 Every 12 mo.* 1 every 12 mo.
Emergency Exam Yes Yes
Fillings Yes Yes
Root Canal PA Required** PA Required***
Retreat Root Canal PA Required--anterior only PA Required--anterior only
Crowns PA Required PA Required
Dentures PA Required PA Required
Extractions Yes Yes
Wisdom Teeth PA Required PA 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.

Primary Care Dentists (PCD)

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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