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WELLNESS REWARDS PROGRAM  DENTAL PLAN OPTIONS







 United Healthcare’s SimplyEngaged Rally Rewards Program rewards you for building healthy habits.  Employees   UNITED CONCORDIA PPO DENTAL PLAN
 and their covered spouses on the United Healthcare medical plans can participate to track your physical activity   United Pacific is offering a Preferred Provider Organization (PPO) dental plan through United Concordia. This PPO
 and earn rewards like gift cards and gym reimbursements. To access this tool, log in to www.myuhc.com and click   dental plan allows you the flexibility to visit dentists that are inside and outside of the United Concordia network.
      When you utilize a “Network” dentist, your out-of-pocket expenses are typically less than using a “Non-Network”
 on the Rally Health Survey button to create an account.
      dentist. Staying in the network allows you to benefit from the negotiated network rates. You may obtain services
      using a non-network dentist, however, you may be responsible for additional charges or even filing claims.
  Available Rewards:
    •   Biometric health screening—learn your numbers               $75 Reward
    •   Complete online health survey within 90 days of starting the program      $25 Reward
    •   Visit participating fitness center at least 12 times per month         $20 / Month
    •   Complete a telephone-based health coaching program            $75 Reward
    •   Complete at least 3 Missions (online action plans)              $50 Reward
    •   Use the myHealthcare Cost Estimator                  $25 Reward  PPO
                                                           NETWORK             NON-NETWORK*
 Maximum reward per member = $200 | Maximum reward per family = $400
                        Annual Maximum Benefit                     $2,000 per Person
                        Calendar Year Deductible
                                         Individual                       $50
                                            Family                        $150

                              Preventive Services            100%                    100%
                                         Plan Pays     Deductible Waived      Deductible Waived
                                   Basic Services       Deductible, 80%         Deductible, 80%
                                         Plan Pays
                                   Major Services       Deductible, 50%         Deductible, 50%
                                         Plan Pays
                                     Orthodontia           50% to $1,500 Lifetime Maximum
                                      Child / Adult                Deductible Waived
                      *Based on fee schedule.
                                                      EMPLOYEE RATE PER PAYCHECK
                                                                    (based on 26 pay periods)
                                     Employee Only                       $18.25
                                 Employee + Spouse                       $35.09
                              Employee + Child(ren)                      $37.19
                                 Employee + Family                       $58.51




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