Page 10 - Non-NC OE Guide
P. 10
Dental Coverage
Access to good oral healthcare can help keep your overall health costs down.
Regular oral health exams can help detect signiicant medical conditions before they
become serious. Dental professionals performing checkups can spot symptoms that
could indicate serious health problems elsewhere in the body that need attention.
Our dental coverage is offered as a separate election from our medical and vision
coverage through UnitedHealthcare.
Dental insurance helps you pay for preventive, basic, major services, and orthodontia
services for dependents under the age of 19.
Make sure to go to a dentist in the network. By going in-network, you pay less—your
portion of the bill is lower due to provider discounts. If you go to a dentist out-of-
network, you pay a higher portion of the bill.
If your current provider is in the network, these providers have agreed to charge
within Reasonable and Customary (R&C) limits. If you visit providers outside the
network, they may charge more than what is considered by the plan to be R&C, and
you will be responsible for the charges over the R&C amount.
To ind a participating provider, visit myuhc.com.
In-Network Out-of-Network
Calendar Year Deductible/Maximum
Individual deductible $25 $25
Family deductible $75 $75
Calendar year maximum $1,000 $1,000
Coinsurance
Preventive services (Exams, x-rays, cleanings) 100% 100%
Basic (Fillings, root canals, oral surgery services) 80% 80%
Major services (Bridges, crowns, dentures) 50% 50%
Orthodontia
Coinsurance 50% 50%
Lifetime maximum $1,500 $1,500
Eligibility To age 19
Dental Plan Cost
Coverage Tier Bi-Weekly Monthly
Employee $11.54 $25.00
Employee + spouse $23.08 $50.00
Employee + child(ren) $18.46 $40.00
Family $34.62 $75.00
10
2015 Open Enrollment
Access to good oral healthcare can help keep your overall health costs down.
Regular oral health exams can help detect signiicant medical conditions before they
become serious. Dental professionals performing checkups can spot symptoms that
could indicate serious health problems elsewhere in the body that need attention.
Our dental coverage is offered as a separate election from our medical and vision
coverage through UnitedHealthcare.
Dental insurance helps you pay for preventive, basic, major services, and orthodontia
services for dependents under the age of 19.
Make sure to go to a dentist in the network. By going in-network, you pay less—your
portion of the bill is lower due to provider discounts. If you go to a dentist out-of-
network, you pay a higher portion of the bill.
If your current provider is in the network, these providers have agreed to charge
within Reasonable and Customary (R&C) limits. If you visit providers outside the
network, they may charge more than what is considered by the plan to be R&C, and
you will be responsible for the charges over the R&C amount.
To ind a participating provider, visit myuhc.com.
In-Network Out-of-Network
Calendar Year Deductible/Maximum
Individual deductible $25 $25
Family deductible $75 $75
Calendar year maximum $1,000 $1,000
Coinsurance
Preventive services (Exams, x-rays, cleanings) 100% 100%
Basic (Fillings, root canals, oral surgery services) 80% 80%
Major services (Bridges, crowns, dentures) 50% 50%
Orthodontia
Coinsurance 50% 50%
Lifetime maximum $1,500 $1,500
Eligibility To age 19
Dental Plan Cost
Coverage Tier Bi-Weekly Monthly
Employee $11.54 $25.00
Employee + spouse $23.08 $50.00
Employee + child(ren) $18.46 $40.00
Family $34.62 $75.00
10
2015 Open Enrollment
