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P A G E 6
Dental Benefits
A comprehensive dental plan is offered through
UnitedHealthcare. Please note that you can save
more money and you receive a greater benefit when
you visit a dentist in the provider network. The national provider network for
UnitedHealthcare is
National Option PPO 20
. To find a dental provider, go to
www.myuhc.com to search for a provider, or call (800) 357-0978.
Employee Payroll Deductions (per pay)
Enrollment Tier
Payroll Deduction
Employee Only
$0.00
Employee/Spouse
$10.00
Employee/Child
$9.00
Employee/Children
$9.00
Family
$15.00
Benefit
UnitedHealthcare Plan P7302
In-Network
Out-of-Network
Annual Deductible (Applies to Basic, Major & Ortho ONLY)
Individual
Family
In and Out-of-Network Combined
$50.00
$150.00
Annual Benefit Maximum (Applies to Basic, Major & Ortho ONLY)
$1,500.00 In and Out-of-Network Combined
Diagnostic & Preventive Services
Examples of covered services include:
Oral Exams,
Radiographs, Dental Prophylaxis (cleanings) Fluoride
Treatments, Sealants, Space Maintainers
100% of covered services 100% of covered services
Basic Dental Services
Examples of covered services include:
Restorations,
General Services (including Emergency Treatment),
General Anesthesia, Simple Extractions, Oral Surgery
(includes surgical extractions), Periodontics, Endodontics
90% of covered services 80% of covered services
Major Dental Services
Examples of covered services include:
Inlays, Onlays
and Crowns; Dentures and other removable prosthetics,
Fixed partial dentures (bridges)
60% of covered services 50% of covered services
Orthodontic Services
Examples of covered services include:
Diagnostic,
Active, Retention Treatments for dependents to age 19
50% of covered services 50% of covered services
Orthodontics ($1,000 Lifetime Ortho Max)
Ortho coverage up to age 19 only
50% of covered services
UnitedHealthcare Plan P7302
Network: National Option PPO 20