Page 7 - 2020 MAS Benefit Guide
P. 7
Dental Coverage Find an In-Network
Access to good oral healthcare can help keep your overall health costs Provider
down. Regular oral health exams can help detect signiicant medical Remember to visit in-network
conditions before they become serious. For these reasons, MAS dentists to receive the deepest
Restaurant continues to partner with UnitedHealthcare to provide dental level of discount on your services.
coverage. To ind a participating in-network
dentist in your area, go to
Visit www.myuhc.com to ind in-network providers and access a variety www.myuhc.com and select
of online tools and programs. “Find a Dentist”(right side of the
page).
Dental PPO Plan
In-Network Out-of-Network Examples of
Calendar Year Deductible Services
Individual $50 X Preventive—exams,
Family $150 cleanings, luoride, x-rays,
Calendar Year Maximum space maintainers, sealants
Per Covered Person $1,000
Coinsurance X Basic—illings, simple
Preventive 100% no deductible 100% no deductible extractions, repairs,
endodontics, periodontics
Basic 80% after deductible 80% after deductible
Major 50% after deductible 50% after deductible X Major—complex oral surgery,
No Coverage for Orthodontia crowns, bridges, inlays,
No coverage dentures
This is a high level summary of your beneit coverage. Full coverage details are available in your
summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
2020 Employee Bi-Weekly Contributions
Employee Only $7.10
Employee + Spouse $15.98
Employee + Child(ren) $13.71
Family $22.82
MAS Restaurant Group 7
Access to good oral healthcare can help keep your overall health costs Provider
down. Regular oral health exams can help detect signiicant medical Remember to visit in-network
conditions before they become serious. For these reasons, MAS dentists to receive the deepest
Restaurant continues to partner with UnitedHealthcare to provide dental level of discount on your services.
coverage. To ind a participating in-network
dentist in your area, go to
Visit www.myuhc.com to ind in-network providers and access a variety www.myuhc.com and select
of online tools and programs. “Find a Dentist”(right side of the
page).
Dental PPO Plan
In-Network Out-of-Network Examples of
Calendar Year Deductible Services
Individual $50 X Preventive—exams,
Family $150 cleanings, luoride, x-rays,
Calendar Year Maximum space maintainers, sealants
Per Covered Person $1,000
Coinsurance X Basic—illings, simple
Preventive 100% no deductible 100% no deductible extractions, repairs,
endodontics, periodontics
Basic 80% after deductible 80% after deductible
Major 50% after deductible 50% after deductible X Major—complex oral surgery,
No Coverage for Orthodontia crowns, bridges, inlays,
No coverage dentures
This is a high level summary of your beneit coverage. Full coverage details are available in your
summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
2020 Employee Bi-Weekly Contributions
Employee Only $7.10
Employee + Spouse $15.98
Employee + Child(ren) $13.71
Family $22.82
MAS Restaurant Group 7
