Page 7 - 2016 Enrollment
P. 7
Olshan Properties
Dental Coverage Eligible employees have access to a
comprehensive dental plan through
Dental Benefit Summary UnitedHealthcare. There will be no
In-Network Out-of-Network changes to the beneits for 2016.
Calendar Year Deductible The plan through UnitedHealthcare
Individual $50 $50 includes coverage for preventive, basic,
Family $150 $150 major dental services, and orthodontia.
Calendar Year Maximum The calendar year maximum is $1,500.
$1,500 $1,500 The calendar year maximum is the
Coinsurance (Plan Pays) maximum amount UnitedHealthcare will
pay towards your dental services each
Preventive 100% no deductible 100% no deductible calendar year, per person covered under
Basic 90% after deductible 80% after deductible the plan.
Major 60% after deductible 50% after deductible
Orthodontia Our dental plan includes the Consumer
Coinsurance 60% no deductible 50% no deductible MaxMultiplier Rollover beneit with UHC.
Members who have at least one dental
Lifetime maximum $1,000 $1,000 visit during a plan year and do not exceed
Beneit applies to Dependent children to age 19 a set threshold are rewarded with dollars
Preventive Services that roll over to the next plan year.
Oral examination 100% no deductible 100% no deductible Dollars may be used for future dental
Prophylaxis, including 100% no deductible 100% no deductible services. Rewards never expire. PPO plan
scaling and polishing members who receive ALL of their care
Fluoride treatment 100% no deductible 100% no deductible from network providers receive additional
Sealants 100% no deductible 100% no deductible reward. Please contact UHC for additional
Space maintainers 100% no deductible 100% no deductible information on this program.
Radiographs 100% no deductible 100% no deductible To ind an in-network dentist, please visit
Basic Services www.myuhcdental.com. When asked to
Restorations 90% after deductible 80% after deductible select a network, choose National Options
Simple extractions 90% after deductible 80% after deductible PPO 30.
Periodontics and 90% after deductible 80% after deductible Also on myuhcdental.com, you have
endodontics access to a Treatment Cost Calculator. The
Oral surgery 90% after deductible 80% after deductible Treatment Cost Calculator provides true
Major Services prices for dental treatment costs based
Crowns, inlays, onlays 60% after deductible 50% after deductible on your plan. You can compare the rates
Dentures and bridges 60% after deductible 50% after deductible charged by different providers and learn
Implants 60% after deductible 50% after deductible about any plan limits. Most importantly,
Bi-Weekly Employee Contributions you can see what your out-of-pocket costs
Employee (Ee) $17.89 will be, so you can plan ahead and avoid
Ee/spouse $35.52 surprises.
Ee/child(ren) $36.13
Family $57.88
7
Dental Coverage Eligible employees have access to a
comprehensive dental plan through
Dental Benefit Summary UnitedHealthcare. There will be no
In-Network Out-of-Network changes to the beneits for 2016.
Calendar Year Deductible The plan through UnitedHealthcare
Individual $50 $50 includes coverage for preventive, basic,
Family $150 $150 major dental services, and orthodontia.
Calendar Year Maximum The calendar year maximum is $1,500.
$1,500 $1,500 The calendar year maximum is the
Coinsurance (Plan Pays) maximum amount UnitedHealthcare will
pay towards your dental services each
Preventive 100% no deductible 100% no deductible calendar year, per person covered under
Basic 90% after deductible 80% after deductible the plan.
Major 60% after deductible 50% after deductible
Orthodontia Our dental plan includes the Consumer
Coinsurance 60% no deductible 50% no deductible MaxMultiplier Rollover beneit with UHC.
Members who have at least one dental
Lifetime maximum $1,000 $1,000 visit during a plan year and do not exceed
Beneit applies to Dependent children to age 19 a set threshold are rewarded with dollars
Preventive Services that roll over to the next plan year.
Oral examination 100% no deductible 100% no deductible Dollars may be used for future dental
Prophylaxis, including 100% no deductible 100% no deductible services. Rewards never expire. PPO plan
scaling and polishing members who receive ALL of their care
Fluoride treatment 100% no deductible 100% no deductible from network providers receive additional
Sealants 100% no deductible 100% no deductible reward. Please contact UHC for additional
Space maintainers 100% no deductible 100% no deductible information on this program.
Radiographs 100% no deductible 100% no deductible To ind an in-network dentist, please visit
Basic Services www.myuhcdental.com. When asked to
Restorations 90% after deductible 80% after deductible select a network, choose National Options
Simple extractions 90% after deductible 80% after deductible PPO 30.
Periodontics and 90% after deductible 80% after deductible Also on myuhcdental.com, you have
endodontics access to a Treatment Cost Calculator. The
Oral surgery 90% after deductible 80% after deductible Treatment Cost Calculator provides true
Major Services prices for dental treatment costs based
Crowns, inlays, onlays 60% after deductible 50% after deductible on your plan. You can compare the rates
Dentures and bridges 60% after deductible 50% after deductible charged by different providers and learn
Implants 60% after deductible 50% after deductible about any plan limits. Most importantly,
Bi-Weekly Employee Contributions you can see what your out-of-pocket costs
Employee (Ee) $17.89 will be, so you can plan ahead and avoid
Ee/spouse $35.52 surprises.
Ee/child(ren) $36.13
Family $57.88
7
