2026 ORI Results Benefits Enrollment Guide

Dental Insurance Benefits Irne gaudl adri t ci ohne ctkou pp rs o, ct el ecat inni gn gysoaunr ds Xm- irlae y, sd. eSnetvael rianl ssut ruadni ec es shuegl pg es spt at hy aftoor rda el nd ti sa el acsaerse, sauncdh uassupa el l ryi oi nd colnutdi tei ss (cgaunmp rdoitseecatsyeo) ,ucaannda fyfoeuc tr of at hmeirl ya rf reoams otfhyeohuirg hb ocdoys t—oifndcel undt ai nl gd iysoeua sr ehaena dr t .s Ru regceeri vyi. n g r e g u l a r d e n t a l c a r e TUhHeCffoolrlotwheinJgancuhaarryt 1below highlights some of the details included in the dental plan offered through st , 202 6 – December 31 st , 202 6 plan year.

Out-of-Network (MAC*) You Pay

In-Network You Pay

Type of service

$50/$150 $50/$150 $1,500 $1,500 20% 20% 50% 50% 0% 0% $ 51 0, 5%0 0 $ 51 0, 5%0 0

Deductible: Applies to basic and major services only (individual/family)

Annual Maximum (per person)

Basic Services: Space Maintainers, Fillings, Extractions, Endodontics, Periodontics, Oral Surgery, Anesthesia Major Services: Inlays, Inlays, Crowns, Bridges, Implants Preventive Services: Oral Exams, Cleanings, Fluoride, Sealants, X-rays

Orthodontia Coverage: Child and Adult (% and Lifetime max per person)

MAC stands for Maximum Allowable Charge (and can sometimes be called a PPO Fee plan) refers tAol l tohwe arbe li emCbhuarrsgeem( eMnAt Cf o) r. Fs oe rr veixc ae ms pp rl eo ,vi ifdyeodu bvyi sai nt aonu ot -uotf--onf e- nt we towr ko rdke dn et ins tt i si st cwahpop ec hd aartgtehse$M1 5a 0x i fmo ru am crelesapnoinnsgib(cleovfoerrethdearte1m00ai%ni)n, gbu$t5t0h.e MAC is set at $100, insurance will cover $100 and you will be Dental Provider Directory Yproouvcidanerlsogin to your UHC account or use the link below to search UHC's directory of In-Network · https://connect.werally.com/plans/uhc · Select Dental Directory - > Employer and Individual Plans -> · Enter your search criteria

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