Page 11 - 2022 ANS Benefit Guide
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Dental Option:
United Healthcare
PAY PERIOD 24 26 Dependent Information
Employee Only No Cost No Cost Our company offers employees the opportunity to
cover their dependent children. Children can join or
Employee + Spouse No Cost No Cost remain on a parent’s dental plan until age 26.
Employee + Child(ren) No Cost No Cost When a child turns 26, they will lose dental coverage
on the last day of their birth month.
Employee + Family No Cost No Cost
Type of Service (In-Network) Amount Paid
Out of Network is at (In-Network Fees)
Preventive Services Covered at 100%; No Deductible
Basic Services Covered at 80% after Calendar Year Deductible
Major Services Covered at 50% after Calendar Year Deductible
Calendar Year Deductible $50 Individual / $150 Family
Annual Maximum $1,000 per person
Waiting Periods for Major Services 12 Month for Major services
The MaxMultipiler Benefit can increase your annual maximum each
year $250 or $350 for (In-Network) providers to a maximum of
Max Rewards
$1,000 in your MaxMultiplier Account. See policy summary for
details!
Type of Service Benefit Description
Preventive Services Oral Exams, Cleanings, X-rays, Sealants, Fluoride Treatment
Fillings, Simple Extractions, Space Maintainers, Oral Surgery,
Basic Services
General Anesthesia, Endodontics and Periodontics
Major Services Crowns, Bridges, Dentures, Inlays & Onlays
Annual Maximum Applies January 1 to December 31
NOTE: This is only a brief overview. Please see the Benefit Summary for more details.
Website: myuhc.com or Customer Service : 877-816-3596
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