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DENTAL BENEFITS
Good dental health is important to your overall well being. At the same time, we all need different levels
of dental treatment. The Unum PPO dental plan provides affordable coverage based on the type of
services obtained –
Preventive, Basic or Major
– whether or not you obtain services from a network or
non-network provider.
Under this plan, you may obtain covered services from any dentist. However, if an out-of-network is used,
reimbursement is based on the 90
th
percentile of charge. Employees who use dentists or dental
specialists that are part of UCCI’s Advantage Plus 2.0 Network
(participating Dental Provider)
will see
reduced or eliminated out-of-pocket expenses.
Annual Maximum rollover:
Each year, you and the dependents on your policy can roll over up to $300 of unused benefit dollars to
the next plan year - as long as each insured individual gets at least one dental exam during the plan year,
and uses less than 50% of the annual maximum in coverage. You can accumulate as much as $1,200 in
rollover dollars.
To find a provider, go to
www.unumdental.comand click on “Find Providers” and select Advantage Plus
2.0 Network.
Dental Benefits Description
Unum/United Concordia Advantage Plus 2.0
In-Network
Out-of-Network
Calendar Year Deductible
(waived for preventive care)
Individual
Family
$50
$150
$50
$150
Preventive Services
Exams, Sealants, Fluoride Treatments, Teeth Cleaning
100%
100%
Basic Services
Fillings, Extractions, General Anesthesia
80%
80%
Major Services
Inlays & Onlays, Crowns, Dentures, Bridges & Periodontal
50%
50%
Orthodontia Services (dep children to age 19 only)
50%
50%
Annual Maximum per member
$2,500
Per Year
$2,500
Per Year
Lifetime Orthodontia Maximum
$1,000
$1,000
Employee Contributions
Employee
Employee + Child(ren)
Employee + Spouse
Family
Employee Bi-Weekly Per Pay Contribution
$3.02
$6.12
$5.96
$9.08