Page 10 - 61st Street Service Corporation | 2022 Benefits

Dental Plan
UnitedHealthcare Dental
(800) 445–9090 Administered by UnitedHealthcare www.myuhcdental.com
Good oral care enhances overall physical health, appearance and mental well-being. Problems with the teeth and gums are common and easily treated health problems. Keep your teeth healthy and your smile bright with the 61st Street Service Corporation Dental Benefits Plan. You have two plan choices for dental coverage: UnitedHealthcare PPO and the UnitedHealthcare Columbia Dental Plan. For members that are enrolled in the CDP, please click here to view the Columbia Dental Plan office locations. Our Consumer MaxMultiplier program rewards you for keeping up with your dental care by adding dollars to next year’s annual maximum. This program is included as part of your dental plan with UHC. Please click here to learn more.
Summary of 2022 Dental Plan Benefits & Costs
UnitedHealthcare PPO
$50 / $150
$1,500 per person*
UnitedHealthcare Columbia Dental Plan
In-Network
Out-of-Network
In-Network
Deductible
(Individual/Family)
Annual Maximum Benefit
Preventive Care
(i.e. exams, cleanings, bitewing x-rays)
Basic Care
(i.e. restorations, simple extractions, periodontics, endodontic)
Major Care
(i.e. inlays, crowns, dentures)
Orthodontia
(PPO: child to age 19 only. CDP: child/adult)
Orthodontia Maximum
Plan pays 100%
Plan pays 80%
Plan pays 50%
Plan pays 50%
Plan pays 100%
Plan pays 80%
Plan pays 50%
Plan pays 50%
$0/$0
$2,000 per person
Plan pays 100%
Plan pays 50%
Plan pays 50%
Plan pays 50%
$2,000 per person
* The Sum of PPO In-Network and Out-of-Network benefits will not exceed the annual maximum.
Please visit www.servcorphr.com to review your summary plan description for a more detailed explanation of benefits and coverage under these plans.
$1,000 per person
10 2022 Benefits Guide