Dental Gen Plans

1 Jul 23 2021 07:12:02 am Dental Gen Plans 4 Plans For Individuals 64+. 1. Hearing Benefit2 included with Option to add Vision Benefits3. Table of Contents Why Dental Gen Plans ? 2 Optional Vision Benefits 6. Dental Gen Saver & Plus 3 Exclusions & Limitations 7. Dental Gen Basic & Deluxe 4 Notice of Privacy Practices 12. Included UnitedHealthcare Hearing Program 5. Golden Rule Insurance Company is the underwriter of these Plans . This product is administered by Dental Benefit Providers, Inc. Policy Forms GRI-DEN3-SR, -50 (AK), -01 (AL), -02 (AZ), -03 (AR), -04 (CA), -05 (CO), -06 (CT), -08 (DC), (DE), -09 (FL), -10 (GA), -51 (HI), -12 (IL), -13 (IN), -14 (IA), -15 (KS), -16 (KY), -17 (LA), -18 (ME), -19 (MD), -21 (MI), -22 (MN), -23 (MS), -24 (MO), -26 (NE), -27 (NV), -28 (NH), -29 (NJ), -30 (NM), -32 (NC), -33 (ND), -35 (OK), -36 (OR), -37 (PA), -38 (RI), -39 (SC), -40 (SD), -41 (TN), -42 (TX), -43 (UT), -44 (VT), -45 (VA), -47 (WV), -48 (WI), and -49 (WY).

2 GRI-DEN3-SR-PBM, -11 (ID), -34 (OH), -46 (WA); GRI-DEN3-SR-PBM-I-46 (WA). 1. Dental Gen Plus is the only plan available in AK, NJ, NV & WY. 2. The hearing benefit is not available in WA. 3. The optional vision benefit is not available in MN, RI or WA. This is an outline only and is not intended to serve as a legal interpretation of benefits. Reasonable effort has been made to have this outline represent the intent of contract language. However, the contract language stands alone and the complete terms of the coverage will be determined by the policy. State-specific differences may apply. 45587B-G-0821. Jul 23 2021 07:12:02 am Helping to Enhance Your Quality of Life Your overall health and well-being rely greatly on your Dental , hearing and vision care. When you smile more, and can hear and see better, life is naturally more enjoyable.

3 Our Dental Gen Plans can help you budget for Dental expenses. PREVENTIVE - BASIC - MAJOR 96% of US adults NO WAITING PERIODS 1. aged 65+ have had a cavity. Center for Disease Control, Our Dental Gen Plans offer you coverage without waiting May 2018. periods so you can start using them right away! This means you have immediate coverage for routine services like exams and cleanings and major repairs like crowns and root canals. NETWORK SAVINGS. Gain access to a nationwide network of over 100,000 Dental INCLUDED coverage . providers4 and receive network HEARING AIDS/EXAMS 2. discounts without the hassle of negotiations. Proper Dental care can Hearing loss is an invisible problem that can affect your help keep issues like gum disease social life, safety and overall well-being. Our Dental Gen and tooth decay at bay saving you Plans include benefits from UnitedHealthcare Hearing.

4 Money on future Dental bills. UnitedHealthcare Hearing has straight-forward benefits for annual hearing exams and hearing aids. In IL & CT, a 6-month waiting period 1. applies on Major services . OPTION TO ADD 2. Hearing benefit not available in WA. VISION BENEFIT 3. 3. ision benefit not available V. in MN, RI, or WA. Vision health and routine eye exams have been linked to the early detection of some medical conditions. Our Dental Gen 4. u Ancillary Specialty Benefits Dental 2018. Plans offer optional coverage for your annual vision exams, plus coverage for glasses or contacts. The vision network includes (Back to cover) private practice and leading retail providers. 2 of 15(Back to cover) 2 of 15. 4 Dental FindGen Plans to a dentist bychoose from: clicking: > Under Links and Tools, select Find a Dentist > Select your state and the National Options PPO 30 network Gen Saver 1,2.

5 Gen Plus 3,2. Designed to offer immediate coverage4 for preventive, This plan pays more for non-network dentists than basic, and major services along with a hearing benefit the other Plans . There is also no waiting period for at our lowest premium. Plan availability varies by state. preventive, basic or major Our Lowest Premium Use Any Dentist Policy pays 60% day one Policy pays 60% day one Preventive Care services 70% after policy year one Preventive Care services 70% after policy year one (includes routine cleaning & exams) (includes routine cleaning & exams). 80% after policy year two 80% after policy year two After Deductible: After Deductible: Policy pays 50% day one Policy pays 50% day one Basic services Basic services 65% after policy year one 65% after policy year one (includes simple fillings & extractions) (includes simple fillings & extractions).

6 80% after policy year two 80% after policy year two Major services Policy pays 10% day one4 Major services Policy pays 10% day one4. (includes crowns, root canals, 40% after policy year one 4 (includes crowns, root canals, 40% after policy year one4. oral surgery, and bridges) 50% after policy year two oral surgery, and bridges) 50% after policy year two coverage Amount $1,000 annual maximum coverage Amount $1,000 annual maximum (per calendar year) (per calendar year). Deductible $100 per person Deductible $100 per person (per calendar year, family max (per calendar year, family max (combined basic and major services ) (combined basic and major services ). 3 deductibles per service type) 3 deductibles per service type). Our Lowest Premium Network Flexibility Most Valuable Feature Most Valuable Feature of Dental Gen Plans of higher non-network benefits Non-Network Network 1.

7 Pays non-network provider benefits based on the network negotiated rate. Comparing Non-Network vs. Network 5. Gen Saver1,2 Gen Plus3,2 Both Plans 2. Non-network dentists can bill a patient for any remaining amount up to the billed charge. 3 Pays non-network provider benefits based on the reasonable Routine Cleaning $ $ $ $ and customary charge. 4 In CT & IL, after a 6-month waiting period, Major services Simple Filling Retail $ You pay: $ $ $ pays 50% and remains 50% after year one. 5 Service pricing in ZIP Code 752-- charges: using policy year one and assuming the plan deductible has been met. Discounts Molar Root Canal $1, $1, $1, $ vary by policy year, type of provider, geographic area, and type of service. PREVENTIVE - BASIC - MAJOR INCLUDED coverage OPTION TO ADD. 3 of 15. NO WAITING PERIODS 4. HEARING AIDS/EXAMS VISION BENEFIT.

8 Jul 23 2021 07:12:02 am 4 Dental FindGen Plans to a dentist bychoose from: clicking: > Under Links and Tools, select Find a Dentist > Select your state and the National Options PPO 30 network Gen Basic 1. Gen Deluxe 1. Start using your plan right away with immediate With our highest annual maximum of $2,000, a lower coverage for preventive services (100%) and basic combined deductible, plus coverage for Dental implants services (50%). Another benefit is the higher annual under major services , this is our most comprehensive max of $1,500. Plan availability varies by state. plan. Plan availability varies by state. 100% Preventive coverage covered Dental Implants Preventive Care services Policy pays 100% day one Preventive Care services Policy pays 100% day one (includes routine cleaning & exams) (includes routine cleaning & exams).

9 After Deductible: After Deductible: Policy pays 50% day one Policy pays 50% day one Basic services 65% after policy year one Basic services 65% after policy year one (includes simple fillings & extractions) (includes simple fillings & extractions). 80% after policy year two 80% after policy year two Major services Policy pays 10% day one2 Major services Policy pays 10% day one2. (includes crowns, root canals, 40% after policy year one2 (includes Dental implants, crowns, 40% after policy year one2. oral surgery, and bridges) 50% after policy year two root canals, oral surgery, and bridges) 50% after policy year two coverage Amount $1,500 annual maximum coverage Amount $2,000 annual maximum (per calendar year) (per calendar year). Deductible $100 per person Deductible $50 per person (per calendar year, family max (per calendar year, family max (combined basic and major services ) (combined basic and major services ).))

10 3 deductibles per service type) 3 deductibles per service type). Policy pays 100% Dental Implant coverage Most Valuable Feature for Preventive Care services Most Valuable Feature & Highest Annual Max & Higher Annual Max Comparing Non-Network vs. Network3 Non-Network1 Network 1. ays non-network provider benefits based on the network negotiated rate. P. Non-network dentists can bill a patient for any remaining amount up to the Routine Cleaning $ $ $0 billed charge. 2 In CT & IL, after a 6-month waiting period, Major services pays Retail 50% and remains 50% after year one. 3 Service pricing in ZIP Code 752-- using Simple Filling charges: $ You pay: $ $ policy year one and assuming the plan deductible has been met. Discounts Molar Root Canal $1, $1, $ vary by policy year, type of provider, geographic area, and type of service.