Page 8 - 61st Street Service Corp. | 2020 EPIC Benefits Guide
P. 8
Dental Plan
Good oral care enhances overall physical health, appearance and mental well-being. Problems with the teeth and gums are common and easily treated health problems. Keep your teeth healthy and your smile bright with the 61st Street Service Corporation Dental Benefits Plan. You have two plan choices for dental coverage: UnitedHealthcare PPO and the UnitedHealthcare Columbia Dental Plan.
Summary of 2020 Dental Plan Benefits & Costs
In-Network Out-of-Network In-Network
UnitedHealthcare Dental
(800) 445 – 9090
www.myuhcdental.com
UnitedHealthcare PPO
UnitedHealthcare Columbia Dental Plan
Deductible (Individual/Family)
$50 / $150
$50 / $150
$0/$0
Annual Maximum Benefit
Basic Care
(i.e. restorations, simple extractions, periodontics, endodontic)
Orthodontia (adult/children)
$1,000 per person
Plan pays 80%
Plan pays 50%
$1,000 per person
Plan pays 80%
Plan pays 50%
$2,000 per person
Plan pays 100% for restorations and simple extractions.
Plan pays 50% for emergency treatment, oral surgery, periodontics and endodontic.
Plan pays 50%
Preventive Care
(i.e. exams, cleanings, bitewing x-rays)
Plan pays 100%
Plan pays 80%
Plan pays 100%
Major Care
(i.e. inlays, crowns, dentures)
Plan pays 50%
Plan pays 50%
Plan pays 50%
Please visit www.servcorphr.com to review your summary plan description for a more detailed explanation of benefits and coverage under these plans.
8 EPIC Backfill Employees | 2020 Benefits Guide
