United Dental and Vision Plan


BENEFITS DETAILS

BENEFIT *

Benefit Comparison3 UNITED SILVER
(PLAN 1)
UNITED GOLD
(PLAN 2)
Policy Year Maximum Benefit $1,000 $1,000 or $2,000 (choose one)
Policy Year Deductible $0 $0
Dental Coverage
Preventive Services4
Examination, cleaning and routine X-Ray2

3 month waiting period
After 90 Days - Up To $125 After 12 Months (and thereafter) 1st Visit Up To $125, 2nd Visit Up To $75 (per policy year) After 90 Days - Up To $125 After 12 Months (and thereafter) 1st Visit Up To $125, 2nd Visit Up To $75 (per policy year)
Basic Services
Including X-Ray, fillings and extractions2

No waiting period
Immediately - 70%
After 12 Months - 80%
After 24 Months - 80%
After 36 Months - 90%

(and thereafter)
Immediately - 60%
After 12 Months - 70%
After 24 Months - 80%
After 36 Months - 90%

(and thereafter)
Major Services
Including bridges, crowns, full dentures or partials, full mouth extractions, and root canals2

12 month waiting period


Not Covered

After 12 Months - 70%
After 24 Months - 80%
After 36 Months - 90%
(and thereafter)
Vision Coverage (not available in Colorado)
Basic eye examination or eye refraction, including the cost of eye glasses or contact lenses2 $150
(per 24 month period)
$150
(per 24 month period)
Waiting Period Exam, first time corrective lenses
No Waiting Period

Repair or replacement of existing eye glasses or contact lenses
6 months
Exam, first time corrective lenses
No Waiting Period

Repair or replacement of existing eye glasses or contact lenses
6 months
Benefits vary by state
1  Benefits are not subject to assignment.
2  Services performed or prescribed by a licensed Medical Professional not a member of your immediate family.
3  Refer to your policy for a complete description of limitations and exclusions.
4  This benefit is included in the Policy Year Maximum Benefit. Only the $125 benefit is available in the first policy year.
*Ohio - Basic Services including X-Ray, fillings and extractions2 No waiting period. United Silver (Policy 1) Year 1 - 70%, Year 2 (and thereafter) - 85%; United Gold (policy 2) Year 1 - 65%, Year 2 (and thereafter) 75%. Major Services including bridges, crowns, full dentures or partials, full mouth extractions, and root canals2 12 month waiting period. United Silver (Policy 1) Not Covered; United Gold (Policy 2) Year 1 - 0%, Year 2 (and thereafter) 75%.

OTHER IMPORTANT BENEFITS