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|Coinsurance||20% - 50%|
|Deductible||$50 per person (maximum three deductibles per family per calendar year)|
|Annual Maximum Benefit||$1,000 per covered person|
|Teeth Cleanings||No charge (twice per calendar year; no waiting period)|
|Restorative Dentistry/Fillings||20% Coinsurance after deductible|
|Oral Surgery||50% Coinsurance after deductible|
|Extractions||20% Coinsurance after deductible|
|X-Rays||No charge (once per calendar year; no waiting period)|
|Crowns||50% Coinsurance after deductible|
|Root Canals||50% Coinsurance after deductible|
|Periodontics||50% Coinsurance after deductible|
|Dentures||50% Coinsurance after deductible (once every 5 years; 12 months waiting period)|
|Topical Fluoride||No charge (twice per calendar year for covered person under age 16; no waiting period)|
|Bridges||50% Coinsurance after deductible (first installation to replace one or more lost functioning natural teeth; 12 months waiting period)|
|Endodontics||50% Coinsurance after deductible|
|A.M. Best Rating||A as of 06/30/2016|
|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.
- Drug Savings amounts shown are only estimates — your costs and savings can differ. Check your plan information for accuracy. See details.
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.