Plan Information

Dental Premier Elite + Vision Plan Benefits

Taking care of your teeth is an important part of your overall health. We can help keep your smile healthy and happy with our Dental Premier Elite Plan that includes preventive care, basic services like fillings, and major services such as root canals.

Dental Premier Elite Plan:

  • Best option if your dentist is not in network.
  • Pays more than other UnitedHealthcare Dental plans for care from non-network dentists.
  • Out-of-Network benefits paid based on the reasonable and customary charges. Benefits may be reduced for covered expenses for care received from a provider outside your network.

Download and review the product brochure for benefits, exclusions, limitations, eligibility and renewal terms. Please select your state:

Schedule of Covered Services and Copayments
    Plan Pays
Preventive Care
No waiting period
Routine dental exams, routine X-rays, and cleanings. Fluoride treatments, sealants, and space maintainers are also covered for children under 16. 100%
Basic Services
6 month waiting period
Simple (nonsurgical) extractions, emergency treatment to ease dental pain, amalgam fillings, resin-based composite fillings, local anesthesia, and general anesthesia but only for the removal of impacted teeth, removal of seven or more teeth, or if necessary in conjunction with complex oral surgery. 80% after deductible
Major Services
12 month waiting period
Treatment for diseases of the pulp (including root canals), bone and other tissues supporting the teeth, crowns, inlays, onlays, veneers, bridges, dentures (payable once every 5 years), surgical extractions, and periodontal maintenance. 50% after deductible
Dental Deductible Combined deductible for Basic and Major services with maximum of 3 individual deductibles per family, per calendar year. $50 per person
Annual Maximum Per calendar year, per person

Year 1: $1,200
Year 2: $1,300
Year 3: $1,400
Year 4+: $1,500

Orthodontics Not covered  

UnitedHealthcare Vision Benefit Rider included with this plan.

Our vision network offers quality care from professionals in private and retail settings across the country*. You may use a non-network provider, but by staying in-network you are eligible to receive better discounts:

See how you can save by using our Vision network

* Network availability may vary by state, and a specific vision care provider’s contract status can change at any time. Therefore, before you receive care, it is recommended that you verify with the vision care provider that he or she is still contracted with the network
** You are eligible to select either eyeglasses (eyeglass lenses and/or eyeglass frames) or contact lenses, not both. Contacts chosen from the “select” contact lenses list at a network provider have the $25 copay but are not limited to an allowance. Non-Selection contacts have no copay but will receive an allowance ($105 for elective contacts/$210 for medically necessary).
This product is administered by Spectera, Inc. Additional premium is included. Availability varies by state.

Service Material In-Network
You Pay
Out-of-Network
You Pay
Eye exam once every 12 months $10 copay Any charge over $40 allowance
Frames once every 24 months Any charge over $130 allowance Any charge over $45 allowance
Single Vision lenses $25 copay Any charge over $40 allowance
Bifocal Lenses $25 copay Any charge over $60 allowance
Trifocal or Lenticular Lenses $25 copay Any charge over $80 allowance
Contacts** in lieu of glasses $25 copay Any charge over $105 allowance

 

•Golden Rule Insurance Company, a UnitedHealthcare Company,�is the underwriter of dental plans. Dental benefits are administered by Dental Benefit Providers, Inc. Vision benefits are administered by Spectera, Inc.
Please Note: Benefits may be reduced for covered expenses for care received from a provider outside your network.
This screen is intended only as general information. It presents only a brief overview of some of the standard benefits of the plan(s) shown. Optional benefits may be available for additional premium.
Before you apply, please use the link(s) provided to download and review the product information for a more complete explanation of benefits, exclusions (including any that may apply to preexisting conditions), limitations, terms under which the plan(s) may not be renewed or benefits may be reduced, and any state variations applicable to any of these items.
You must meet our eligiblity requirements in order to become insured, which may include medical underwriting. There is no coverage until we inform you in writing that your application has been processed and approved.
To be considered for reimbursement, expenses must qualify as "covered expenses" under the policy, and are also subject to all other policy provisions, such as reasonable and customary or eligible expense limits, or whether or not they were necessary.
Estimated Premium shown is based on the information you provided, and is subject to change based on the plan you select, optional benefits you select (if any), and other factors. We shall exclusively determine the premium actually required, and the effective date of any coverage issued.
Download and review the product brochure
for benefits, exclusions, limitations, eligibility and renewal terms. Please select your state: