Horizons Diagnostics, LLC - Physicians - 2024 Benefits Guide

Dental Coverage

Good dental care is critical to your overall well-being. With Unum Dental Insurance, you can get the attention your teeth need - at a cost you can afford. To get the most from your benefits and reduce out-of-pocket costs, choose an in-network provider by utilizing our large national network. These providers have agreed to file your claims and uphold the highest quality standards. You can find in-network providers at unum.com/dental-providers

Insurance Carrier:

Unum Dental Insurance

Plan Type:

Base Plan

Buy-Up Plan

Calendar Year Deductible Calendar Year Maximum

$50 Individual / $150 Family

$50 Individual / $150 Family

$1,000

$2,000

Preventive Services

100%

100%

Basic Services Major Services Carryover Benefit

80% 50%

80% 50%

Up to $250

Up to $400 * $1,500 *

Orthodontia (see below)

N/A

Out-of-Network Reimbursement Employee Monthly Deduction Employee Only

90th Percentile

90th Percentile

$29.10 $65.51 $64.91 $103.35

$46.42 $91.77 $114.29 $172.21

Employee + Spouse Employee + Child(ren)

Family

*Orthodontia Coverage is available for any eligible employee to purchase under the Buy-Up plan.*

16 HORIZONS DIAGNOSTICS LLC 2024 BENEFITS GUIDE

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