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Find an In-
Network Provider
Remember to visit in-network Dental Coverage
dentists to receive the deepest
level of discount on your Access to good oral healthcare can help keep your overall health costs down. Regular
services. oral health exams can help detect signiicant medical conditions before they become
To find a participating in- serious. Dental professionals performing checkups can spot symptoms which could
network dentist in your area
go to www.myuhc.com indicate serious health problems elsewhere in the body which need attention. For
for current members or these reasons, and many others, we offer a dental insurance beneit to our employees.
www.uhc.com for future
members. You may also call
877.816.3596. Dental coverage is provided by UnitedHealthcare.
Orthodontia Services In-Network Out-of-Network
Note Calendar Year Deductible
The lifetime maximum Individual $50 $50
illustrated is different from Family
the calendar year maximum. $150 $150
For orthodontia services, this Calendar Year Maximum $1,000
limit does not reset each year, Coinsurance
this is the most your plan will Preventive 0% no deductible
cover for your services for the
lifetime of your participation in Basic 20% after deductible
this program. Major 50% after deductible
Orthodontia
Examples of Services Coinsurance
X Preventive—exams, 50% no deductible
cleanings, fluoride, x-rays, Lifetime Maximum $1,000
sealants Benefit Applies To Child(ren) under age 20
X Basic—fillings, extractions,
periodontics, repairs, and This is a high level summary of your beneit coverage. Full coverage details are
oral surgery available in your summary plan description (SPD). In the event there is a discrepancy
X Major—crowns, inlays,
onlays, dentures, implants between what is relected in this guide and what is communicated in your SPD, the
terms of your SPD will prevail.
Monthly Contributions
Employee $13.04
Family $33.90
12
Airport Terminal Services
Network Provider
Remember to visit in-network Dental Coverage
dentists to receive the deepest
level of discount on your Access to good oral healthcare can help keep your overall health costs down. Regular
services. oral health exams can help detect signiicant medical conditions before they become
To find a participating in- serious. Dental professionals performing checkups can spot symptoms which could
network dentist in your area
go to www.myuhc.com indicate serious health problems elsewhere in the body which need attention. For
for current members or these reasons, and many others, we offer a dental insurance beneit to our employees.
www.uhc.com for future
members. You may also call
877.816.3596. Dental coverage is provided by UnitedHealthcare.
Orthodontia Services In-Network Out-of-Network
Note Calendar Year Deductible
The lifetime maximum Individual $50 $50
illustrated is different from Family
the calendar year maximum. $150 $150
For orthodontia services, this Calendar Year Maximum $1,000
limit does not reset each year, Coinsurance
this is the most your plan will Preventive 0% no deductible
cover for your services for the
lifetime of your participation in Basic 20% after deductible
this program. Major 50% after deductible
Orthodontia
Examples of Services Coinsurance
X Preventive—exams, 50% no deductible
cleanings, fluoride, x-rays, Lifetime Maximum $1,000
sealants Benefit Applies To Child(ren) under age 20
X Basic—fillings, extractions,
periodontics, repairs, and This is a high level summary of your beneit coverage. Full coverage details are
oral surgery available in your summary plan description (SPD). In the event there is a discrepancy
X Major—crowns, inlays,
onlays, dentures, implants between what is relected in this guide and what is communicated in your SPD, the
terms of your SPD will prevail.
Monthly Contributions
Employee $13.04
Family $33.90
12
Airport Terminal Services
