Page 10 - Lanter | 2022 Benefits Guide LAF
P. 10
Find a Dental Provider DENTAL
Your out-of-pocket costs are lower when you visit an in-
network dentist. To ind an in-network dentist, follow these We partner with UnitedHealthcare to offer you and
steps. your family members dental insurance.
X Visit www.myuhc.com Out-of-
In-Network
X Select Find a Dentist under Links and Tools Calendar Year Deductible Network
X Select your state and select the National Options PPO 30 Per Individual $0 $25
network Per Family $0 $75
X Enter the name of your provider or if you are looking for a Calendar Year Maximum $1,000
nearby dentist, enter the city and state and/or ZIP Code Ortho Lifetime Maximum $1,000
Coinsurance
X Select the desired specialty; click Search Preventive—Exams, Cleanings, 100%
X-Rays, Fluoride, Sealants, Space
Maintainers
Basic—Fillings, Emergency Exams, 80%*
Simple Extractions, Periodontics,
Endodontics, Oral Surgery
Major—Crowns, Inlays, Onlays, 50%*
Bridges, Dentures
Orthodontia—Children to age 19 50%
* Basic and major services covered after deductible out-of-network.
Premium Per Pay Period
Employee $10.94
Employee and Spouse $23.98
Get Rewarded for Taking Care of Employee and Child(ren) $27.56
$42.25
Family
Your Smile
Earn up to $350 to add to your $1,000 annual maximum.
Orthodontia Services
Earn award dollars for visiting your dentist at least The orthodontia lifetime maximum illustrated here
once a year.
Your award dollars will help to pay for claims that go is different than the calendar year maximum. For
beyond your annual maximum. orthodontia services, this limit does not reset each year,
Unused award dollars can roll over each year. this is the most your plan will cover for your services
for the lifetime of your participation in this program.
10 2021-22 ENROLLMENT GUIDE
Your out-of-pocket costs are lower when you visit an in-
network dentist. To ind an in-network dentist, follow these We partner with UnitedHealthcare to offer you and
steps. your family members dental insurance.
X Visit www.myuhc.com Out-of-
In-Network
X Select Find a Dentist under Links and Tools Calendar Year Deductible Network
X Select your state and select the National Options PPO 30 Per Individual $0 $25
network Per Family $0 $75
X Enter the name of your provider or if you are looking for a Calendar Year Maximum $1,000
nearby dentist, enter the city and state and/or ZIP Code Ortho Lifetime Maximum $1,000
Coinsurance
X Select the desired specialty; click Search Preventive—Exams, Cleanings, 100%
X-Rays, Fluoride, Sealants, Space
Maintainers
Basic—Fillings, Emergency Exams, 80%*
Simple Extractions, Periodontics,
Endodontics, Oral Surgery
Major—Crowns, Inlays, Onlays, 50%*
Bridges, Dentures
Orthodontia—Children to age 19 50%
* Basic and major services covered after deductible out-of-network.
Premium Per Pay Period
Employee $10.94
Employee and Spouse $23.98
Get Rewarded for Taking Care of Employee and Child(ren) $27.56
$42.25
Family
Your Smile
Earn up to $350 to add to your $1,000 annual maximum.
Orthodontia Services
Earn award dollars for visiting your dentist at least The orthodontia lifetime maximum illustrated here
once a year.
Your award dollars will help to pay for claims that go is different than the calendar year maximum. For
beyond your annual maximum. orthodontia services, this limit does not reset each year,
Unused award dollars can roll over each year. this is the most your plan will cover for your services
for the lifetime of your participation in this program.
10 2021-22 ENROLLMENT GUIDE
