UHC Dental Plans UHC PPO UHC HMO UHC EPO
Plan Features In-Network Out-of-Network In-Network Only In & Out-of-Network
Calendar Year Deductibles
Individual $50 $0 $50
Family $150 $0 $150
Maximum
Calendar Year $1,000 per person $0 $1,250/Dental Services
$1,500/Orthodontic Services
Waiting Period 12-month waiting period for Major Services No waiting period for Major Services 12-month waiting period for Orthodontic Services
No waiting period for Major Services
Visits and Exams
Office Visit
Oral Exam
X-rays
You pay 0% You pay any charges in excess of Allowed Amount* Office visit: $5
Oral Exam: $0
X-rays: $0
Copays vary by service according to Patient Charge Schedule*
Basic Services
Fillings
General Services
Space Maintainers
You pay 20% You pay 20% and any charges in excess of Allowed Amount* Copays vary by service according to Patient Charge Schedule* Copays vary by service according to Patient Charge Schedule*
Major Services
Crowns
Dentures/Bridges
You pay 50% You pay 50% and any charges in excess of Allowed Amount* Copays vary by service according to Patient Charge Schedule* Copays vary by service according to Patient Charge Schedule*
Orthodontic Services
Orthodontia Not Covered Not Covered Copays vary by service according to Patient Charge Schedule*
Adult and children Orthodontia: No waiting period
Copays vary by service according to Patient Charge Schedule*
Children only (up to 19 yrs)

* The benefit percentage applies to the schedule of maximum allowable charges. Maximum allowable charges are limitations on billed charges in the geographic area in which the expenses are incurred.