
Contact the provider of these benefits by calling this phone number or visiting this website:
Group # 908012
844-298-1010
Website: myuhc.com
Dental Plans Highlights
UHC | Low, Mid & High Plan
Preventive
Procedures that dentists use to diagnose, monitor, and maintain a patient's oral health:
- Cleaning and oral exam
- Fluoride treatment
- Sealants
- X-rays
Basic
Treatments that are relatively straightforward and don’t involve a significant laboratory expense:
- Filling
- Tooth removal
- Root canal
- Anesthesia
Major
Procedures that are more complex and often involve a dental laboratory expense:
- Bridges and dentures
- Inlays, onlays, and veneers
- Crowns, bridges, and dentures (repair & maintenance)
Orthodontia
Specialist care and corrective action to align bite and/or straighten teeth:
- Appliances, including braces and retainers
- Only available to children on the plan
Low Plan
In-Network Only
Annual Deductible (Individual / Family)
$50 / $150
Annual Maximum
$750
Preventive & Diagnostic Services
Covered 100%
Basic Restorative Services
Covered 50%
Major Restorative Services
Covered 25%
Oral Surgery
Covered 25%
Endodontics Services
Covered 25%
Periodontics Services
Covered 25%
Orthodontia (child[ren] only)
Not covered
Out-of-Network
Annual Deductible (Individual / Family)
Not covered
Annual Maximum
Not covered
Preventive & Diagnostic Services
Not covered
Basic Restorative Services
Not covered
Major Restorative Services
Not covered
Oral Surgery
Not covered
Endodontics Services
Not covered
Periodontics Services
Not covered
Orthodontia (child[ren] only)
Not covered
Mid Plan
In-Network
Annual Deductible (Individual / Family)
$50 / $150
Annual Maximum
$1,000
Preventive & Diagnostic Services
Covered 100%
Basic Restorative Services
Covered 80%
Major Restorative Services
Covered 50%
Oral Surgery
Covered 50%
Endodontics Services
Covered 50%
Periodontics Services
Covered 50%
Orthodontia (child[ren] only)
You pay 50%; $1,000 lifetime max
Out-of-Network
Annual Deductible (Individual / Family)
$50 / $150
Annual Maximum
$1,000
Preventive & Diagnostic Services
Covered 100% of MPA
Basic Restorative Services
Covered 80% of MPA
Major Restorative Services
Covered 50% of MPA
Oral Surgery
Covered 50% of MPA
Endodontics Services
Covered 50% of MPA
Periodontics Services
Covered 50% of MPA
Orthodontia (child[ren] only)
50%; $1,000 lifetime max
High Plan
In-Network
Annual Deductible (Individual / Family)
$50 / $150
Annual Maximum
$2,000
Preventive & Diagnostic Services
Covered 100%
Basic Restorative Services
Covered 80%
Major Restorative Services
Covered 50%
Oral Surgery
Covered 80%
Endodontics Services
Covered 80%
Periodontics Services
Covered 80%
Orthodontia (child[ren] only)
You pay 50%; $1,000 lifetime max
Out-of-Network
Annual Deductible (Individual / Family)
$50 / $150
Annual Maximum
$1,000
Preventive & Diagnostic Services
Covered 100% of MPA
Basic Restorative Services
Covered 80% of MPA
Major Restorative Services
Covered 50% of MPA
Oral Surgery
Covered 80% of MPA
Endodontics Services
Covered 80% of MPA
Periodontics Services
Covered 80% of MPA
Orthodontia (child[ren] only)
50%; $1,000 lifetime max
Dental Rates
Twice monthly (Sep-Jun) Pre-Tax Contributions. Payment is deducted in advance of start date. Please pay attention to the medical and without medical rates below
Employee Only
Low Plan (Medical / Without Medical)
$8.79 / $0.00
Mid Plan (Medical / Without Medical)
$16.54 / $0.00
High Plan (Medical / Without Medical)
$25.39 / $0.00
Employee + 1
Low Plan (Medical / Without Medical)
$15.61 / $6.82
Mid Plan (Medical / Without Medical)
$31.99 / $15.46
High Plan (Medical / Without Medical)
$49.12 / $23.73
Employee + 2 or More
Low Plan (Medical / Without Medical)
$23.21 / $14.42
Mid Plan (Medical / Without Medical)
$51.40 / $34.86
High Plan (Medical / Without Medical)