|Deductible||$50 per person (combined basic and major services)|
|Annual Maximum Benefit||We pay up to: $1,500 per person, per calendar year|
|Teeth Cleanings||0% Coinsurance for day one|
|Restorative Dentistry/Fillings||50% Coinsurance for day one, 35% Coinsurance after policy year one, 20% Coinsurance after policy year two|
|Oral Surgery||90% Coinsurance for day one, 60% Coinsurance after policy year one, 50% Coinsurance after policy year two|
|Extractions||50% Coinsurance for day one, 35% Coinsurance after policy year one, 20% Coinsurance after policy year two|
|X-Rays||0% Coinsurance for day one (Bitewing - limited to 1 series per calendar year; Full mount panoramic - limited to 1 per 36 months)|
|Crowns||90% Coinsurance for day one, 60% Coinsurance after policy year one, 50% Coinsurance after policy year two|
|Root Canals||90% Coinsurance for day one, 60% Coinsurance after policy year one, 50% Coinsurance after policy year two|
|Topical Fluoride||0% Coinsurance for day one|
|Sealant||0% Coinsurance for day one|
|A.M. Best Rating||A as of 12/18/2018|
|Electronic Signature for Application Available||Yes|
|Details and documents about this plan|
|View Plan Brochure Exclusions and Limitations|
Important notices and disclaimers
- The benefits matrix is a summary for informational purposes only. Review the evidence of coverage and insurance policy (plan contract) for a detailed description of coverage benefits, limitations, and exclusions. Only the terms and conditions of coverage benefits listed in the policy are binding.
- The benefits listed may be contingent on your use of physicians, hospitals, dentists and services within the specific insurance company's provider network.
- The Copayment, Deductible, and Coinsurance amounts are your share of the costs for covered benefits. These amounts are subject to change.
- The quotes or rates shown above are estimates only. Your premium is subject to change based on your medical history (pursuant to state law of residence), the underwriting practices of the insurance company, the optional benefits you selected, if any, and other relevant factors, such as changes in rates which take effect before your requested effective date. The insurance company always determines your actual premium. Insurance companies reserve the right to change the terms of a policy upon proper notification.
Carrier specific notices, disclaimers and fees
- UnitedHealthcare - Golden Rule Insurance Company, a UnitedHealthcare Company, is the underwriter of dental plans.
- UnitedHealthcare - Dental benefits are administered by Dental Benefit Providers, Inc. Vision benefits are administered by Spectera, Inc.
- UnitedHealthcare - Please Note: Benefits may be reduced for covered expenses for care received from a provider outside your network.
- UnitedHealthcare - This screen is intended only as general information. It presents only a brief overview of some of the standard benefits of the plan(s) shown. Optional benefits may be available for additional premium.
- UnitedHealthcare - Before you apply, please use the link(s) provided to download and review the product information for a more complete explanation of benefits, exclusions (including any that may apply to preexisting conditions), limitations, terms under which the plan(s) may not be renewed or benefits may be reduced, and any state variations applicable to any of these items.
- UnitedHealthcare - You must meet our eligibility requirements in order to become insured, which may include medical underwriting. There is no coverage until we inform you in writing that your application has been processed and approved.
- UnitedHealthcare - To be considered for reimbursement, expenses must qualify as "covered expenses" under the policy, and are also subject to all other policy provisions, such as reasonable and customary or eligible expense limits, or whether or not they were necessary.
- UnitedHealthcare - Estimated Premium shown is based on the information you provided, and is subject to change based on the plan you select, optional benefits you select (if any), and other factors. We shall exclusively determine the premium actually required, and the effective date of any coverage issued.