Page 9 - PSA 2020-21 New Hire Guide
P. 9
Protection Strategies Incorporated
Dental Remember to visit in-network dentists to receive the deepest
We partner with United Healthcare to offer you level of discount on your services.
and your family members dental insurance. Visit To ind a participating in-network dentist in your area, go to
www.myuhc.com.
www.myuhc.com to ind in-network providers and
access a variety of online tools and programs.
Orthodontia Services Note
Calendar Year Deductible The lifetime maximum illustrated is diferent from the
calendar year maximum. For orthodontia services, this limit
Individual $50 does not reset each year, this is the most your plan will
Family $150 cover for your services for the lifetime of your participation
Calendar Year Maximum in this program.
$1,500
Coinsurance Examples of Services
Preventive 100% no deductible X Preventive—exams, cleanings, luoride, x-rays, and
Basic 90% after deductible sealants
Major 60% after deductible X Basic—illings, extractions, periodontics, repairs, and
Orthodontia oral surgery
Coinsurance 50% after deductible X Major—crowns, inlays, dentures, and dental impacts
Lifetime Maximum $1,500
Beneit Applies to Adults and children
This is a high level summary of your beneit coverage. Full coverage
details are available in your summary plan description (SPD). In the event
there is a discrepancy between what is relected in this guide and what is
communicated in your SPD, the terms of your SPD will prevail.
Semi-Monthly Pre-Tax Employee
Dental Contributions
Employee Only $12.71
Employee and Spouse $25.47
Employee and Child(ren) $33.18
Family $51.31
* Employees classiied as SCA, see page 19 for employer deductions to
health and welfare.
9
Dental Remember to visit in-network dentists to receive the deepest
We partner with United Healthcare to offer you level of discount on your services.
and your family members dental insurance. Visit To ind a participating in-network dentist in your area, go to
www.myuhc.com.
www.myuhc.com to ind in-network providers and
access a variety of online tools and programs.
Orthodontia Services Note
Calendar Year Deductible The lifetime maximum illustrated is diferent from the
calendar year maximum. For orthodontia services, this limit
Individual $50 does not reset each year, this is the most your plan will
Family $150 cover for your services for the lifetime of your participation
Calendar Year Maximum in this program.
$1,500
Coinsurance Examples of Services
Preventive 100% no deductible X Preventive—exams, cleanings, luoride, x-rays, and
Basic 90% after deductible sealants
Major 60% after deductible X Basic—illings, extractions, periodontics, repairs, and
Orthodontia oral surgery
Coinsurance 50% after deductible X Major—crowns, inlays, dentures, and dental impacts
Lifetime Maximum $1,500
Beneit Applies to Adults and children
This is a high level summary of your beneit coverage. Full coverage
details are available in your summary plan description (SPD). In the event
there is a discrepancy between what is relected in this guide and what is
communicated in your SPD, the terms of your SPD will prevail.
Semi-Monthly Pre-Tax Employee
Dental Contributions
Employee Only $12.71
Employee and Spouse $25.47
Employee and Child(ren) $33.18
Family $51.31
* Employees classiied as SCA, see page 19 for employer deductions to
health and welfare.
9
