City of Athens 2023 Enrollment Guide

DENTAL INSURANCE
CARRIER: UNITEDHEALTHCARE
● You will pay less out of pocket when you choose an in-network provider.
● Locate an in-network provider at www.uhc.com – Find a Dentist. Network is
National Options PPO 30.
● Be sure to ask for a pre-treatment estimate.
● Out-of-network providers can balance bill, or bill you for the difference between
the provider’s charge and the allowed amount.
ELECTION
MONTHLY
DEDUCTION
1ST & 2ND PAY
PERIOD DEDUCTION
Employee Only $0.00 $0.00
Employee + 1 $33.78 $16.89
Employee + 2 or more $70.26 $35.13
COVERED BENEFITS
PLAN PAYS
Deductible (per calendar year)
Annual Plan Benefit Maximum
Diagnostic & Preventive Services
Oral evaluation, radiographs, lab and other diagnostic tests,
cleanings, fluoride treatment, sealants, space maintainers
Basic Services
Periodontal & endodontic services, extractions, restorations,
oral surgery, emergency treatment/general services
Major Services
Bridges, crowns, inlays/onlays, dentures (full/partial)
$50 per person, $150 per family
applies to basic and major services
$1,500 per covered member
100%
Orthodontia Services 50%
Lifetime Orthodontia Plan Max $1,000
Annual Maximum Carryover
80%
50%
Included
This Plan includes a roll-over maximum benefit. Some of the unused portion of your annual maximum
may be available in future periods. See page 23 for details.
22