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) $8 .76
Ee/Spouse $17 .39
Ee/Child(ren) $17 .70
Family $28 .35
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) $8 .76
Ee/Spouse $17 .39
Ee/Child(ren) $17 .70
Family $28 .35
6
