Learn more about Dental Insurance
Dental Plan Design
UHC | For more details, please refer to the plan document.
Base Plan
In-Network
Calendar Year Deductible (Individual / Family)
$50 / $150
Calendar Year Maximum
$1,500
Preventive & Diagnostic Services
Covered 100%
Basic Restorative Services
20% after deductible
Major Restorative Services
50% after deductible
Orthodontia
Not covered
Out-of-Network1
Calendar Year Deductible (Individual / Family)
$50 / $150
Calendar Year Maximum
$1,000
Preventive & Diagnostic Services
Covered 100%
Basic Restorative Services
20% after deductible
Major Restorative Services
50% after deductible
Orthodontia
Not covered
Buy-Up Plan
In-Network
Calendar Year Deductible (Individual / Family)
$50 / $150
Calendar Year Maximum
$2,000
Preventive & Diagnostic Services
Covered 100%
Basic Restorative Services
20% after deductible
Major Restorative Services
30% after deductible
Orthodontia (child[ren] only)
50% after deductible; $2,000 lifetime max
Out-of-Network1
Calendar Year Deductible (Individual / Family)
$50 / $150
Calendar Year Maximum
$1,000
Preventive & Diagnostic Services
Covered 100%
Basic Restorative Services
20% after deductible
Major Restorative Services
50% after deductible
Orthodontia (child[ren] only)
50% after deductible; $1,200 lifetime max
- Out of network coinsurance will pay the same percentage, but the reimbursement is based on out of network rates. You may be balance billed for the difference.
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
Contribution Rates
Biweekly Pre-Tax Contributions (26 Pay Periods)
Employee Only
Base Plan
$2.00
Buy-Up Plan
$5.00
Employee & Spouse
Base Plan
$8.00
Buy-Up Plan
$9.00
Employee & Child(ren)
Base Plan
$9.00
Buy-Up Plan
$10.00
Employee & Family
Base Plan
$20.00
Buy-Up Plan
$35.00
Contact the provider of these benefits by calling this phone number or visiting this website: (888) 475-6206, myuhc.com
This Digital Benefits Guide is intended to highlight available benefits and should not be relied upon to fully determine coverage. The benefits plan may not cover all health care expenses. More complete descriptions of benefits and the terms under which they are provided are contained in the Certificate of Coverage that you will receive upon request. If this Digital Benefits Guide conflicts in any way with the policy issued by the employer, the policy shall prevail.