Page 12 - The Raymond Group Supplemental Benefit Guide

DENTAL & VISION INCLUDED WITH THE MEDICAL

THROUGH THE SOUTHWEST CARPENTERS TRUST FUND

Please note: the Trust Fund provides a Dental and Vision Plan which you do not need to enroll in because you will automatically be
enrolled once the Trust Fund Office receives your medical enrollment application.

You have the choice between the Select Managed Care Direct Compensation (DC) Plan—a DHMO Plan—or the Dental Preferred
Provider Organization (DPPO) Plan.

• Select Managed Care Direct Compensation (DC) Plan—a DHMO Plan: The DC Plan is a Dental Health Maintenance
Organization (DHMO), which contracts with selected dentists. It is designed to encourage you and your family to visit the
dentist regularly to maintain your dental health. You must select a dentist at the time of enrollment from the UHC network, or
one will be chosen for you. The UHC network consists of private practice dental facilities that have been carefully screened for
quality. Visit welcometouhc.com/csac for the copayment schedule and to find network dentists.

• Under the DPPO Plan, you pay a percentage of the cost for dental services instead of copays. Also, you can choose from a
larger network of dentists than under the DHMO Plan. In addition, the DPPO gives you access to out-of-network dentists. Visit
welcometouhc.com/csac for information on how the DPPO Plan pays benefits

The Trust only offers one Vision Plan to participants. It is the UnitedHealthcare Vision Plan. If you have questions about network
vision providers or the benefits available, contact UnitedHealthcare toll free at (800) 638-3120 or visit their website at
myuhcvision.com.

Vision benefits are administered through UnitedHealthcare Vision regardless of which Medical plan you enroll with.
UnitedHealthcare Customer Service: (800) 638-3120 ; UnitedHealthcare Provider Locator: (800) 839-3242 or myuhcvision.com
• No claim forms are required. Claims (in or out of network) will be processed by UnitedHealthcare Vision.
• You may have an eye exam and lenses (or contacts) once every 12months.
• You may have frames once every 24 months.

12 Employee Benefits