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D ental
Dental beneits are offered through UnitedHealthcare (UHC). Two plan
design options are available for selection. A summary of each plan is
highlighted below.
Beneit highlights include:
Broad access to in-network providers—with an expansive selection of
in-network providers you have a better chance of avoiding additional
out-of-pocket exposure or “balance billing”; balance billing is the
practice of non-network providers billing the patient for amounts that
exceed the reimbursement amount under a patient’s dental plan; the
patient is responsible for the additional amounts charged; therefore, it
is important to stay in-network to avoid excess charges
TMJ coverage is included in our dental plan coverage up to a separate
beneit maximum of $1,000
To search for UHC participating dentists visit www.myuhcdental.com or
call 800.445.9090.
D ental P lans C ore P lan— O ption 1 B uy- U p P lan— O ption 2
I n- N etw ork I n- N etw ork
D ed uctible $ 5 0 P er person/ $ 1 5 0 $ 5 0 P er person/ $ 1 5 0
per family ( w aiv ed for per family ( w aiv ed for
prev entiv e) prev entiv e)
A nnual max imum $ 1 , 0 0 0 P er person $ 1 , 0 0 0 P er person
O rtho lifetime max imum N ot cov ered $ 1 , 0 0 0 P er child
P rev entiv e serv ices 1 0 0 % 1 0 0 %
( cleanings, ex ams, x - rays)
Basic services (illings, 8 0 % 8 0 %
simple ex tractions, root
canal)
M aj or serv ices ( crow ns, N ot cov ered 5 0 %
oral surgery, d entures)
O rthod ontia N ot cov ered 5 0 %
( child ren und er age 1 9 )
This summary of beneits is intended to be a brief outline of coverage. The entire provisions of
beneits and exclusions are contained in the Summary Plan Description (SPD). In the event of a
conlict between the SPD and this description, the terms of the SPD will prevail.
2016 Open Enrollment
D ental
Dental beneits are offered through UnitedHealthcare (UHC). Two plan
design options are available for selection. A summary of each plan is
highlighted below.
Beneit highlights include:
Broad access to in-network providers—with an expansive selection of
in-network providers you have a better chance of avoiding additional
out-of-pocket exposure or “balance billing”; balance billing is the
practice of non-network providers billing the patient for amounts that
exceed the reimbursement amount under a patient’s dental plan; the
patient is responsible for the additional amounts charged; therefore, it
is important to stay in-network to avoid excess charges
TMJ coverage is included in our dental plan coverage up to a separate
beneit maximum of $1,000
To search for UHC participating dentists visit www.myuhcdental.com or
call 800.445.9090.
D ental P lans C ore P lan— O ption 1 B uy- U p P lan— O ption 2
I n- N etw ork I n- N etw ork
D ed uctible $ 5 0 P er person/ $ 1 5 0 $ 5 0 P er person/ $ 1 5 0
per family ( w aiv ed for per family ( w aiv ed for
prev entiv e) prev entiv e)
A nnual max imum $ 1 , 0 0 0 P er person $ 1 , 0 0 0 P er person
O rtho lifetime max imum N ot cov ered $ 1 , 0 0 0 P er child
P rev entiv e serv ices 1 0 0 % 1 0 0 %
( cleanings, ex ams, x - rays)
Basic services (illings, 8 0 % 8 0 %
simple ex tractions, root
canal)
M aj or serv ices ( crow ns, N ot cov ered 5 0 %
oral surgery, d entures)
O rthod ontia N ot cov ered 5 0 %
( child ren und er age 1 9 )
This summary of beneits is intended to be a brief outline of coverage. The entire provisions of
beneits and exclusions are contained in the Summary Plan Description (SPD). In the event of a
conlict between the SPD and this description, the terms of the SPD will prevail.
2016 Open Enrollment
