2024-Framebridge-Benefit Guide

DENTAL BENEFITS

Framebridge offers two dental plans, a Low plan and a High plan. Both utilize United HealthCare's National Options PPO 30 dental network. To find a provider go to www.myuhc.com.

DPPO LOW PLAN

DPPO HIGH PLAN

BENEFIT

IN-NETWORK

OUT-OF-NETWORK

IN-NETWORK

OUT-OF-NETWORK

Annual Deductible

Individual: $50 Family: $150

Individual: $50 Family: $150

Individual: $50 Family: $150

Individual: $50 Family: $150

Annual Benefit Maximum

$1,000 per person

$1,000 per person

$2,000 per person

$2,000 per person

Diagnostic & Preventive Services Oral examinations; Cleanings; Fluoride; Sealants; Bitewing Images; Full mouth series images; Space maintainers Basic Services Basic Restoration; General Services; Root Canal Therapy; Oral Surgery (includes surgical extraction); Simple extractions; Endodontics; Periodontics Major Services Bridges, Dentures and Other Removeable Prosthetics; Fixed Partial Dentures; Crowns, Inlays/Onlays/Crowns

100% deductible waived

100% deductible waived

100% deductible waived

100% deductible waived

70% after deductible

70% after deductible

90% after deductible

80% after deductible

40% after deductible

40% after deductible

60% after deductible

50% after deductible

Orthodontic Services (children only up to age 19) Lifetime Maximum

50% $1,000

50% $1,000

Not covered

Not covered

Dental Contributions Per Pay Period Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

$2.34 $11.54 $10.48 $17.52

$6.21 $19.19 $18.63 $30.33

DENTAL BENEFITS THAT GIVE YOU FREEDOM AND CHOICE With the UnitedHealthcare Dental PPO Plan, you can see any dentist you want, anywhere you want, anywhere across the country. When you choose a dentist who is part of your plan’s large national network, you may receive discounted rates only available to members. PREVENTATIVE CARE When you see a network dentist, your plan pays for all or most of your preventative dental care, including routine checkups, cleanings and annual oral cancer screenings for adults. You can get two cleanings in a 12- month period. Oral Health is linked to overall health. That’s why we emphasize preventative care, so small dental problems don’t become big ones that negatively affect overall health.

EXTRA DENTAL VISITS WHEN YOU’RE PREGNANT Increased bacteria levels in a persons mouth can lead to tooth decay. Your plan covers extra visits for cleanings and gum treatments when you're pregnant, as recommended by your dentist. Ask your dentists to submit a claim to the address on your ID card. Be sure to include the name of your OB/GYN and your due date. BENEFITS ON THE GO Check the UnitedHealthcare Dental app, visit myuhc.com or call the number on the back of your ID card to learn more about your benefit summary.

• Find a neighborhood dentist. • Set appointment reminders. • Access helpful health tips.

For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

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