Page 11 - Lanter Delivery Systems 2021 Benefits Guide
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Lanter Delivery Systems, LLC Benefits Enrollment Guide
Dental Find a Dental Provider
We partner with UnitedHealthcare to offer you Your out-of-pocket costs are lower when you visit an in-
and your family members dental insurance. network dentist. To ind an in-network dentist, follow these
Visit www.myuhc.com to ind in-network providers steps.
and access a variety of online tools and programs. Visit www.myuhc.com
Out-of-
In-Network Network Select Find a Dentist under Links and Tools
Select your state and select the National Options PPO
Calendar Year Deductible 30 network
Per Individual $0 $25
Per Family $0 $75 Enter the name of your provider or if you are looking
Calendar Year Maximum $1,000 for a nearby dentist, enter the city and state and/or
Coinsurance ZIP Code
Preventive—Exams, Cleanings, 100% after deductible
X-Rays, Fluoride, Sealants, Space Select the desired specialty; click Search
Maintainers
Basic—Fillings, Emergency Exams, 80% after deductible
Simple Extractions, Periodontics,
Endodontics, Oral Surgery
Major—Crowns, Inlays, Onlays, 50% after deductible
Bridges, Dentures
Premium Per Pay Period
Employee $5.47
Employee and Spouse $11.99
Employee and Child(ren) $13.78
Family $21.13
Orthodontia Services
The orthodontia lifetime maximum illustrated here
is different than the calendar year maximum. For Get Rewarded for Taking Care of
orthodontia services, this limit does not reset each year, Your Smile
this is the most your plan will cover for your services Earn up to $350 to add to your $1,000 annual maximum.
for the lifetime of your participation in this program.
Earn award dollars for visiting your dentist at least
once a year.
Your award dollars will help to pay for claims that
go beyond your annual maximum.
Unused award dollars can roll over each year.
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Dental Find a Dental Provider
We partner with UnitedHealthcare to offer you Your out-of-pocket costs are lower when you visit an in-
and your family members dental insurance. network dentist. To ind an in-network dentist, follow these
Visit www.myuhc.com to ind in-network providers steps.
and access a variety of online tools and programs. Visit www.myuhc.com
Out-of-
In-Network Network Select Find a Dentist under Links and Tools
Select your state and select the National Options PPO
Calendar Year Deductible 30 network
Per Individual $0 $25
Per Family $0 $75 Enter the name of your provider or if you are looking
Calendar Year Maximum $1,000 for a nearby dentist, enter the city and state and/or
Coinsurance ZIP Code
Preventive—Exams, Cleanings, 100% after deductible
X-Rays, Fluoride, Sealants, Space Select the desired specialty; click Search
Maintainers
Basic—Fillings, Emergency Exams, 80% after deductible
Simple Extractions, Periodontics,
Endodontics, Oral Surgery
Major—Crowns, Inlays, Onlays, 50% after deductible
Bridges, Dentures
Premium Per Pay Period
Employee $5.47
Employee and Spouse $11.99
Employee and Child(ren) $13.78
Family $21.13
Orthodontia Services
The orthodontia lifetime maximum illustrated here
is different than the calendar year maximum. For Get Rewarded for Taking Care of
orthodontia services, this limit does not reset each year, Your Smile
this is the most your plan will cover for your services Earn up to $350 to add to your $1,000 annual maximum.
for the lifetime of your participation in this program.
Earn award dollars for visiting your dentist at least
once a year.
Your award dollars will help to pay for claims that
go beyond your annual maximum.
Unused award dollars can roll over each year.
11
