Dental
Dental plans cover diagnostic and preventive care, plus basic and major services. Although you can choose any dental provider, you will generally pay less when you visit an in-network dentist.
Premiums (Bi-Weekly)
| Coverage Tier | Base Plan You Pay | Base Plan NOVA Pays | Buy-Up Plan You Pay | Buy-Up Plan NOVA Pays |
|---|---|---|---|---|
| Employee | $5.12 | $10.78 | $6.43 | $13.66 |
| Employee + Spouse | $10.16 | $22.10 | $12.84 | $27.91 |
| Employee + Child(ren) | $9.71 | $20.73 | $12.26 | $26.18 |
| Family | $12.98 | $27.97 | $16.40 | $35.33 |
Employee
- Base Plan You Pay
- $5.12
- Base Plan NOVA Pays
- $10.78
- Buy-Up Plan You Pay
- $6.43
- Buy-Up Plan NOVA Pays
- $13.66
Employee + Spouse
- Base Plan You Pay
- $10.16
- Base Plan NOVA Pays
- $22.10
- Buy-Up Plan You Pay
- $12.84
- Buy-Up Plan NOVA Pays
- $27.91
Employee + Child(ren)
- Base Plan You Pay
- $9.71
- Base Plan NOVA Pays
- $20.73
- Buy-Up Plan You Pay
- $12.26
- Buy-Up Plan NOVA Pays
- $26.18
Family
- Base Plan You Pay
- $12.98
- Base Plan NOVA Pays
- $27.97
- Buy-Up Plan You Pay
- $16.40
- Buy-Up Plan NOVA Pays
- $35.33
Coverage Details
| Feature | Base Plan In-network | Base Plan Out-of-network | Buy-Up Plan In-network | Buy-Up Plan Out-of-network |
|---|---|---|---|---|
| Annual deductible (Individual/Family) | $50 / $150 | $50 / $150 | $50 / $150 | $50 / $150 |
| Annual maximum (per person) | $1,000 | $1,000 | $1,500 | $1,500 |
| Diagnostic and preventive care (Includes cleanings, fluoride treatments, and sealants) | 100% | 100% | 100% | 100% |
| Basic services (Including periodontics, extractions, and simple extractions) | 80% | 80% | 80% | 80% |
| Major services (includes crowns, bridges, and full and partial dentures) | 50% | 50% | 50% | 50% |
| Orthodontia (Adult and Child) | Not Covered | Not Covered | 50% | 50% |
| Lifetime maximum | Not Applicable | Not Applicable | $1,500 | $1,500 |
Annual deductible (Individual/Family)
- Base Plan In-network
- $50 / $150
- Base Plan Out-of-network
- $50 / $150
- Buy-Up Plan In-network
- $50 / $150
- Buy-Up Plan Out-of-network
- $50 / $150
Annual maximum (per person)
- Base Plan In-network
- $1,000
- Base Plan Out-of-network
- $1,000
- Buy-Up Plan In-network
- $1,500
- Buy-Up Plan Out-of-network
- $1,500
Diagnostic and preventive care (Includes cleanings, fluoride treatments, and sealants)
- Base Plan In-network
- 100%
- Base Plan Out-of-network
- 100%
- Buy-Up Plan In-network
- 100%
- Buy-Up Plan Out-of-network
- 100%
Basic services (Including periodontics, extractions, and simple extractions)
- Base Plan In-network
- 80%
- Base Plan Out-of-network
- 80%
- Buy-Up Plan In-network
- 80%
- Buy-Up Plan Out-of-network
- 80%
Major services (includes crowns, bridges, and full and partial dentures)
- Base Plan In-network
- 50%
- Base Plan Out-of-network
- 50%
- Buy-Up Plan In-network
- 50%
- Buy-Up Plan Out-of-network
- 50%
Orthodontia (Adult and Child)
- Base Plan In-network
- Not Covered
- Base Plan Out-of-network
- Not Covered
- Buy-Up Plan In-network
- 50%
- Buy-Up Plan Out-of-network
- 50%
Lifetime maximum
- Base Plan In-network
- Not Applicable
- Base Plan Out-of-network
- Not Applicable
- Buy-Up Plan In-network
- $1,500
- Buy-Up Plan Out-of-network
- $1,500
- Plan includes out-of-network benefits; see plan summary for additional details.
Plan Notes
- Orthodontia is not covered under the Base Plan.
- Although you can choose any dental provider, you will generally pay less when you visit an in-network dentist. If you choose an out-of-network provider, you may be billed the difference between what UnitedHealthcare pays, and what your out-of-network provider charges for the services.
- Orthodontia (adult and child) is covered at 50%, up to a $1,500 lifetime maximum.