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Dental benefits

The dental plan uses a passive PPO network which means the benefit
coverage is the same whether you see an in or out-of-network provider.
However, you benefit from negotiated discounts with in-network providers.
Should you use an out-of-network provider, your benefits will be subject to
reasonable and customary cost limits. If your out-of-network provider charges
more than that limit, they may balance bill you for the difference.

You may search for an in-network dentist by visiting myuhcdental.com.
Dental benefits summary

Covered Services Benefit Guideline
Deductible $50 Individual / $100 Family
Annual Maximum Benefit $2,000
Preventive Care (includes 2 cleanings per calendar year and deductible 100%
and annual benefit maximum do not apply)
Basic Care 80%
Major Care 50%
Orthodontia for dependent children (6-18 years old) 50% (no deductible)
Orthodontia Lifetime Maximum (per covered child) $2,000

Dental plan premiums for full-time employees
The following table shows the full monthly premium, the premium amount
TXM pays on your behalf, and your monthly cost. Your premium deduction
begins with the first pay period following your benefit enrollment effective
date.

Full Monthly TXM Employee Monthly
Coverage Option
Premium Contribution
Employee Only $58.00 $44.00 $14.00
Employee & Children $98.00 $64.00 $34.00
Employee & Spouse $105.00 $67.00 $38.00
Employee & Family $144.00 $84.00 $60.00

Section 125 plan and flexible spending accounts

A Flexible Spending Account (FSA) allows you to pay for eligible expenses
with pre-tax dollars under Section 125 of the Internal Revenue Code. When
you pay for these expenses with pre-tax dollars, you do not pay Social
Security, Medicare, or federal income tax on your contributions.
Benefit premiums under section 125
Premiums for medical, dental and the optional cancer insurance will be
deducted from your pay on a pre-tax basis under Section 125 of the IRS Code.

Employee Benefits Guide 9