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)
$78.90 / $53.51
Please Note: Dependents are eligible up to the end of the calendar year they turn age 30 if they are unmarried and live in Florida or attend school full time in another state; or if they are physically or mentally disabled and fully dependent on you for support.