(Hourly) 2019 McKibbon Benefit Guide

DENTAL INSURANCE

McKibbon Hospitality offers dental coverage through United Healthcare. The Dental PPO Plan allows you to use in-network or out-of-network providers. Find in-network providers on www.myuhc.com by clicking on “Find Dentist” and searching within the “Options PPO 30” network. If out-of-network dentists are used, you will be responsible for paying the difference between United Healthcare’s allowed amount and what the dentist may charge, also known as “balance billing”. The chart below provides a brief overview of the plan.

DPPO PLAN

In-Network

Calendar Year Deductible (applies to basic & major services only)

Individual

$50

Family

$150

Annual Maximum (per covered member)

Per covered member

$1,000

Preventive Services

Exams, Cleanings, & Fluoride

Covered in full

Basic Services

Fillings, Simple Extractions, Oral surgeries, Periodontics, & Endodontics

Covered 70% after deductible

Major Services

Crowns, Bridges, & Dentures

Covered 50% after deductible

Out-of Network 1

Calendar Year Deductible

$50 / $150

Schedule of Services: Preventive

Covered 100% Covered 70% after deductible Covered 50% after deductible

Basic Major

Annual Maximum (pre covered member)

$ 1,000

80 th Usual & Customary Charges

Basis of Payment

Bi-Weekly Cost for Coverage

$10.31

Employee Only

$25.97

Employee + Spouse

$24.67

Employee + Child(ren)

$38.95

Employee + Family

1 Subject to balance billing. Please refer to your plan document for specific details. Copies can be found within forms library on the Benefits Portal.

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