Page 6 - 2015 New Hire Guide
P. 6
New Hire
Beneits Guide
Dental
Coverage Dental Benefit Summary
In-Network Out-of-Network
Eligible employees have access to a Calendar Year Deductible
comprehensive dental plan through Individual $50 $50
UnitedHealthcare. Family $150 $150
The plan through UnitedHealthcare Calendar Year Maximum
includes coverage for preventive, basic, $1,500 $1,500
major dental services, and orthodontia. Coinsurance
The calendar year maximum is $1,500. Preventive 100% no deductible 100% no deductible
The calendar year maximum is the Basic 90% after deductible 80% after deductible
maximum amount UnitedHealthcare
will pay towards your dental services Major 60% after deductible 50% after deductible
each calendar year, per person covered Orthodontia
under the plan. Coinsurance 60% no deductible 50% no deductible
Lifetime Maximum $1,000 $1,000
Our dental plan includes the Consumer Beneit applies to
MaxMultiplier Rollover beneit with Dependent children to age 19
UHC. Members who have at least one Preventive Services
dental visit during a plan year and Oral examination 100% no deductible 100% no deductible
do not exceed a set threshold are Prophylaxis, including 100% no deductible 100% no deductible
rewarded with dollars that roll over to scaling and polishing
the next plan year. Dollars may be used Fluoride Treatment 100% no deductible 100% no deductible
for future dental services. Rewards Sealants 100% no deductible 100% no deductible
never expire. PPO plan members who Space Maintainers 100% no deductible 100% no deductible
receive ALL of their care from network Radiographs 100% no deductible 100% no deductible
providers receive additional reward. Basic Services
Please contact UHC for additional Restorations 90% after deductible 80% after deductible
information on this program.
Simple Extractions 90% after deductible 80% after deductible
To ind an in-network dentist, please Periodontics & Endodontics 90% after deductible 80% after deductible
visit www.myuhcdental.com. When Oral Surgery 90% after deductible 80% after deductible
asked to select a network, choose Major Services
National Options PPO 30.
Crowns, Inlays, Onlays 60% after deductible 50% after deductible
Dentures and Bridges 60% after deductible 50% after deductible
Implants 60% after deductible 50% after deductible
Bi-Weekly Employee Contributions
Employee (Ee) $17.89
Ee/Spouse $35.52
Ee/Child(ren) $36.13
Family $57.88
6
Beneits Guide
Dental
Coverage Dental Benefit Summary
In-Network Out-of-Network
Eligible employees have access to a Calendar Year Deductible
comprehensive dental plan through Individual $50 $50
UnitedHealthcare. Family $150 $150
The plan through UnitedHealthcare Calendar Year Maximum
includes coverage for preventive, basic, $1,500 $1,500
major dental services, and orthodontia. Coinsurance
The calendar year maximum is $1,500. Preventive 100% no deductible 100% no deductible
The calendar year maximum is the Basic 90% after deductible 80% after deductible
maximum amount UnitedHealthcare
will pay towards your dental services Major 60% after deductible 50% after deductible
each calendar year, per person covered Orthodontia
under the plan. Coinsurance 60% no deductible 50% no deductible
Lifetime Maximum $1,000 $1,000
Our dental plan includes the Consumer Beneit applies to
MaxMultiplier Rollover beneit with Dependent children to age 19
UHC. Members who have at least one Preventive Services
dental visit during a plan year and Oral examination 100% no deductible 100% no deductible
do not exceed a set threshold are Prophylaxis, including 100% no deductible 100% no deductible
rewarded with dollars that roll over to scaling and polishing
the next plan year. Dollars may be used Fluoride Treatment 100% no deductible 100% no deductible
for future dental services. Rewards Sealants 100% no deductible 100% no deductible
never expire. PPO plan members who Space Maintainers 100% no deductible 100% no deductible
receive ALL of their care from network Radiographs 100% no deductible 100% no deductible
providers receive additional reward. Basic Services
Please contact UHC for additional Restorations 90% after deductible 80% after deductible
information on this program.
Simple Extractions 90% after deductible 80% after deductible
To ind an in-network dentist, please Periodontics & Endodontics 90% after deductible 80% after deductible
visit www.myuhcdental.com. When Oral Surgery 90% after deductible 80% after deductible
asked to select a network, choose Major Services
National Options PPO 30.
Crowns, Inlays, Onlays 60% after deductible 50% after deductible
Dentures and Bridges 60% after deductible 50% after deductible
Implants 60% after deductible 50% after deductible
Bi-Weekly Employee Contributions
Employee (Ee) $17.89
Ee/Spouse $35.52
Ee/Child(ren) $36.13
Family $57.88
6
