The First Commonwealth HMO is a dental maintenance organization (DMO) that provides dental care from a network of dentists and generally emphasizes preventive services.
The plan covers eligible services at 100% minus a specified copayment. A complete listing of eligible services and copayments amounts is available in the Schedule of Member Payment Responsibilities
.
|
You |
You + spouse |
You + child(ren) |
You+Sps+Child(ren) |
|
|
Full Time |
$7 |
$13 |
$14 |
$20 |
|
Part Time |
$10 |
$19 |
$20 |
$28 |
First Commonwealth only covers dental care services which are authorized in advance by an individual's primary care dentist. Enrollment in First Commonwealth requires the designation of a primary care dentist.
This plan does not require the completion of claim forms. If you receive a bill, you should contact First Commonwealth directly.