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Dental
Dental beneits are offered through UnitedHealthcare (UHC). Two plan
design options are available for selection. A summary of each plan is
highlighted below.
Beneit highlights include:
Broad access to in-network providers—with an expansive selection of
in-network providers you have a better chance of avoiding additional
out-of-pocket exposure or “balance billing”; balance billing is the
practice of non-network providers billing the patient for amounts that
exceed the reimbursement amount under a patient’s dental plan; the
patient is responsible for the additional amounts charged; therefore, it
is important to stay in-network to avoid excess charges
TMJ coverage is included in our dental plan coverage up to a separate
beneit maximum of $1,000
To search for UHC participating dentists visit www.myuhcdental.com or
call 800.445.9090.
Dental Plans Core Plan—Option 1 Buy-Up Plan—Option 2
In-Network In-Network
Deductible $50 Per person/$150 $50 Per person/$150
per family (waived for per family (waived for
preventive) preventive)
Annual maximum $1,000 Per person $1,000 Per person
Ortho lifetime maximum Not covered $1,000 Per child
Preventive services 100% 100%
(cleanings, exams, x-rays)
Basic services (illings, 80% 80%
simple extractions, root
canal)
Major services (crowns, Not covered 50%
oral surgery, dentures)
Orthodontia Not covered 50%
(children under age 19)
This summary of beneits is intended to be a brief outline of coverage. The entire provisions of
beneits and exclusions are contained in the Summary Plan Description (SPD). In the event of a
conlict between the SPD and this description, the terms of the SPD will prevail.
2016 Open Enrollment
Dental
Dental beneits are offered through UnitedHealthcare (UHC). Two plan
design options are available for selection. A summary of each plan is
highlighted below.
Beneit highlights include:
Broad access to in-network providers—with an expansive selection of
in-network providers you have a better chance of avoiding additional
out-of-pocket exposure or “balance billing”; balance billing is the
practice of non-network providers billing the patient for amounts that
exceed the reimbursement amount under a patient’s dental plan; the
patient is responsible for the additional amounts charged; therefore, it
is important to stay in-network to avoid excess charges
TMJ coverage is included in our dental plan coverage up to a separate
beneit maximum of $1,000
To search for UHC participating dentists visit www.myuhcdental.com or
call 800.445.9090.
Dental Plans Core Plan—Option 1 Buy-Up Plan—Option 2
In-Network In-Network
Deductible $50 Per person/$150 $50 Per person/$150
per family (waived for per family (waived for
preventive) preventive)
Annual maximum $1,000 Per person $1,000 Per person
Ortho lifetime maximum Not covered $1,000 Per child
Preventive services 100% 100%
(cleanings, exams, x-rays)
Basic services (illings, 80% 80%
simple extractions, root
canal)
Major services (crowns, Not covered 50%
oral surgery, dentures)
Orthodontia Not covered 50%
(children under age 19)
This summary of beneits is intended to be a brief outline of coverage. The entire provisions of
beneits and exclusions are contained in the Summary Plan Description (SPD). In the event of a
conlict between the SPD and this description, the terms of the SPD will prevail.
2016 Open Enrollment
