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DENTAL INSURANCE

ASSURANT/SUN LIFE | DHMO DENTAL PLAN (CA RESIDENTS ONLY)
With the Dental Health Maintenance Organization (DHMO) plan through Assurant/Sun Life, you are required to select a general
dentist who is a member of the network to provide your dental care. You will contact your general dentist for all of your dental needs,
such as routine check-ups and emergency situations. If specialty care is needed, your general dentist will provide the necessary
referral. For covered procedures, you'll pay the pre-set copay or coinsurance fee described in your DHMO plan booklet. Please
keep a copy of your booklet to refer to when utilizing your dental care. This will show the applicable copays that apply to all of the
dental services that are covered under this plan.

ASSURANT/SUN LIFE | PPO DENTAL PLANS
With the Assurant/Sun Life Preferred Provider Organization (PPO) dental plans, you may visit a PPO dentist and benefit from the
negotiated rate or visit a non-network dentist. When you utilize a PPO dentist, your out-of-pocket expenses will be less. You may
also obtain services using a non-network dentist; however, you will be responsible for the difference between the covered amount
and the actual charges and you may be responsible for filing claims.

ASSURANT / ASSURANT / SUN LIFE ASSURANT / SUN LIFE
SUN LIFE
DHMO LOW PPO HIGH PPO
Network Name Network Network Non-Network Network Non-Network
DENTAL BENEFITS
Office Visit Copay $5 Copay N/A N/A N/A N/A
Calendar Year Maximum Benefit Unlimited $1,000 $1,000 $1,500 $1,200
Annual Deductible
• Individual $0 $50 $75 $50 $75
• Family $0 3x Individual 3x Individual 3x Individual 3x Individual
Preventive Services (Plan Pays) 100% for 100% 80% 100% 100%
• Deductible Waived Most Services Yes No Yes No
Basic Services (Plan Pays) See Schedule 80% 60% 90% 75%
Major Services (Plan Pays) See Schedule 50% 40% 60% 50%
ORTHODONTIA BENEFITS
Covered Family Members Adult/Child Child Only Child Only Child Only Child Only
Copay $1,695 / $1,895 N/A N/A N/A N/A
Coinsurance N/A 50% 50% 50% 50%
Lifetime Benefit Maximum N/A $1,000 $1,000 $1,250 $1,250

FINDING A DENTAL PROVIDER:
• DHMO: www.sunlife.com/findadentist. Under DHMO or Prepaid Dental Plan? Select California from
drop down list. Click on CA UDC Prepaid and a new screen will open where you can enter your location
information and begin your search.
• DPPO: www.sunlife.com/findadentist. Under PPO Plan? Select Assurant Dental Network. Hit Go and
a new screen will open where you can enter your location information and begin your search.

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