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Small Group Dental Plans
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UHC Dental Plans
AM Best Rating: A
NCQA: Excellent
UnitedHealthcare provides a full spectrum of small employer dental plans. UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and well-being company.
In Network Only Plans
UnitedHealthcare's hottest plans. Using a large PPO network of dentists, employees can be offered unheard of annual maximums up to $3,500. Rates are awesome and employees can use any PPO provider, but have no access to dentists outside the large PPO network. Search PPO Dentists by clicking here.
PPO Plans
Traditional plans allowing the use of PPO dentists or a dentist out of network. With some plans "out of network dentists" can be paid at the 85th or 90th percentile of Usual & Customary (UCR) charges. Other plan designs use a "maximum allowable charge" for paying out of network providers. Search PPO Dentists by clicking here.
DHMO Plans
The lowest cost plans available because they use a smaller list of dentists than the PPO list discussed above. These plans offer copays similar to HMO health plans. Employees must choose a specific dentist during enrollment to direct their dental care. Search DHMO Dentists by clicking here.
In Network Only Plans
| IN NETWORK Only Plans | ||||||||||
| Plan | Prev. & Diag | Minor Rest. | Endo/ Perio |
Crown & Brd | Ortho | Deduct | Ortho Elig | Ann. Max | Life Ortho | Voluntary? |
| PIN52 | 100% | 50% | 50% | 50% | 0% | 50/150 | N/A | $ 1,500 | No | |
| PIN53 | 100% | 50% | 50% | 50% | 0% | 50/150 | N/A | $ 1,500 | Yes | |
| PIN55 | 100% | 80% | 50% | 50% | 50% | 25/75 | Child & Adult | $ 3,500 | $1,500 | Yes |
| PIN56 | 100% | 80% | 50% | 50% | 0% | 25/75 | N/A | $ 3,500 | $ - | Yes |
| PIN57 | 100% | 80% | 50% | 50% | 50% | 25/75 | Child & Adult | $ 3,500 | $1,500 | No |
| PIN58 | 100% | 80% | 50% | 50% | 0% | 25/75 | N/A | $ 3,500 | $ - | No |
PPO Plans
In Network Benefits (Outside network see bottom chart)
| Plan | Type | Waiting Period | Prev. & Diag | Minor Rest. | Endo | Perio | Crown & Brd | Ortho | Deduct | Ortho Elig | Ann. Max | Life Ortho | CMM? | Vol? | |
| P0018 | Passive | 12 Months | 100% | 80% | 80% | 80% | 50% | 50% | 50/150 | Child Only | $1,500 | $1,500 | No | No | |
| P3306 | Incentive | 12 Months | 100% | 80% | 50% | 50% | 50% | 0% | 50/150 | N/A | $1,000 | Yes | Yes | ||
| P3337 | Passive | 12 Months | 100% | 80% | 50% | 50% | 50% | 0% | 50/150 | N/A | $1,000 | Yes | Yes | ||
| P3350 | Incentive | None | 100% | 80% | 50% | 50% | 50% | 0% | 50/150 | N/A | $1,500 | Yes | Yes | ||
| P3354 | Incentive | 12 Months | 100% | 90% | 60% | 60% | 60% | 0% | 50/150 | N/A | $1,500 | Yes | Yes | ||
| P3378 | Passive | None | 100% | 80% | 80% | 80% | 50% | 0% | 50/150 | N/A | $1,000 | Yes | Yes | ||
| P3362 | Incentive | None | 100% | 90% | 60% | 60% | 60% | 0% | 50/150 | N/A | $2,000 | Yes | Yes | ||
| P3388 | Passive | None | 100% | 80% | 80% | 80% | 50% | 50% | 50/150 | Child Only | $1,500 | $1,500 | Yes | Yes | |
| P3434 | Incentive | None | 100% | 80% | 80% | 80% | 50% | 0% | 50/150 | N/A | $1,000 | Yes | No | ||
| P3439 | Incentive | None | 100% | 80% | 80% | 80% | 50% | 0% | 50/150 | N/A | $1,500 | Yes | No | ||
| P3486 | Incentive | None | 100% | 80% | 80% | 80% | 50% | 0% | 50/150 | N/A | $1,000 | Yes | No | ||
| P3389 | Passive | None | 100% | 80% | 80% | 80% | 50% | 0% | 50/150 | N/A | $1,500 | Yes | Yes | ||
| P4210 | Incentive | None | 100% | 90% | 90% | 90% | 60% | 0% | 50/150 | N/A | $1,000 | Yes | No | ||
| P4212 | Incentive | None | 100% | 90% | 90% | 90% | 60% | 50% | 50/150 | Child Only | $1,000 | $1,000 | Yes | No | |
| P4213 | Incentive | None | 100% | 90% | 90% | 90% | 60% | 0% | 50/150 | N/A | $1,500 | Yes | No | ||
| P4214 | Incentive | None | 100% | 90% | 90% | 90% | 60% | 50% | 50/150 | Child & Adult | $1,500 | $1,500 | Yes | No | |
| P4216 | Incentive | None | 100% | 90% | 90% | 90% | 60% | 0% | 50/150 | N/A | $2,000 | Yes | No | ||
| P4878 | Passive | None | 100% | 80% | 50% | 50% | 50% | 50% | 50/150 | Child Only | $1,000 | $1,000 | Yes | No | |
| P4879 | Passive | None | 100% | 80% | 80% | 80% | 50% | 0% | 50/150 | N/A | $1,000 | Yes | No | ||
| P4881 | Passive | None | 100% | 80% | 50% | 50% | 50% | 0% | 50/150 | N/A | $1,500 | Yes | No | ||
| P4883 | Passive | None | 100% | 80% | 80% | 80% | 50% | 0% | 50/150 | N/A | $1,500 | Yes | No | ||
| P4980 | Passive | None | 100% | 80% | 80% | 80% | 50% | 50% | 50/150 | Child & Adult | $2,000 | $2,000 | Yes | No | |
| P4983 | Incentive | None | 100% | 90% | 90% | 90% | 60% | 50% | 50/150 | Child Only | $2,000 | $1,000 | Yes | No | |
| P5329 | Incentive | None | 100% | 80% | 80% | 80% | 50% | 0% | 50/150 | N/A | $1,000 | Yes | No | ||
| P5330 | Incentive | None | 100% | 80% | 80% | 80% | 50% | 0% | 50/150 | N/A | $1,500 | Yes | No | ||
| P5331 | Incentive | None | 100% | 90% | 90% | 90% | 60% | 50% | 50/150 | Child Only | $1,500 | $1,000 | Yes | No | |
| P5300 | Passive | None | 100% | 80% | 80% | 80% | 50% | 50% | 50/150 | Child Only | $2,500 | $1,000 | Yes | No |
Out of Network Benefits
| Plan | Prev. & Diag | Minor Rest. | Endo | Perio | Crown & Brd | Ortho | Deduct | Ortho Elig | Ann. Max | Life Ortho | UCR |
| P0018 | 100% | 80% | 80% | 80% | 50% | 50% | 50/150 | Child Only | $1,500 | $1,500 | 85% |
| P3306 | 80% | 50% | 50% | 50% | 50% | 0% | 50/150 | N/A | $1,000 | MAC | |
| P3337 | 100% | 80% | 50% | 50% | 50% | 0% | 50/150 | N/A | $1,000 | 85% | |
| P3350 | 80% | 60% | 50% | 50% | 50% | 0% | 50/150 | N/A | $1,500 | 85% | |
| P3354 | 100% | 80% | 50% | 50% | 50% | 0% | 50/150 | N/A | $1,500 | 85% | |
| P3378 | 100% | 80% | 80% | 80% | 50% | 0% | 50/150 | N/A | $1,000 | 85% | |
| P3362 | 100% | 80% | 50% | 50% | 50% | 0% | 50/150 | N/A | $2,000 | 85% | |
| P3388 | 100% | 80% | 80% | 80% | 50% | 50% | 50/150 | Child Only | $1,500 | $1,500 | 85% |
| P3434 | 80% | 60% | 60% | 60% | 50% | 0% | 50/150 | N/A | $1,000 | 85% | |
| P3439 | 80% | 60% | 60% | 60% | 50% | 0% | 50/150 | N/A | $1,000 | 85% | |
| P3486 | 80% | 50% | 50% | 50% | 50% | 0% | 50/150 | N/A | $1,000 | 85% | |
| P3389 | 100% | 80% | 80% | 80% | 50% | 0% | 50/150 | N/A | $1,500 | 85% | |
| P4210 | 100% | 80% | 80% | 80% | 50% | 0% | 50/150 | N/A | $1,000 | 85% | |
| P4212 | 100% | 80% | 80% | 80% | 50% | 50% | 50/150 | Child Only | $1,000 | $1,000 | 85% |
| P4213 | 100% | 80% | 80% | 80% | 50% | 0% | 50/150 | N/A | $1,500 | 85% | |
| P4214 | 100% | 80% | 80% | 80% | 50% | 50% | 50/150 | Child & Adult | $1,500 | $1,500 | 85% |
| P4216 | 100% | 80% | 80% | 80% | 50% | 0% | 50/150 | N/A | $2,000 | 85% | |
| P4878 | 100% | 80% | 50% | 50% | 50% | 50% | 50/150 | Child Only | $1,000 | $1,000 | 90% |
| P4879 | 100% | 80% | 80% | 80% | 50% | 0% | 50/150 | N/A | $1,000 | 90% | |
| P4881 | 100% | 80% | 50% | 50% | 50% | 0% | 50/150 | N/A | $1,500 | 90% | |
| P4883 | 100% | 80% | 80% | 80% | 50% | 0% | 50/150 | N/A | $1,500 | 90% | |
| P4980 | 100% | 80% | 80% | 80% | 50% | 50% | 50/150 | Child & Adult | $2,000 | $2,000 | 90% |
| P4983 | 100% | 80% | 80% | 80% | 50% | 50% | 50/150 | Child Only | $2,000 | $1,000 | 90% |
| P5329 | 70% | 50% | 50% | 50% | 50% | 0% | 50/150 | N/A | $750 | MAC | |
| P5330 | 70% | 50% | 50% | 50% | 50% | 0% | 50/150 | N/A | $1,000 | MAC | |
| P5331 | 70% | 50% | 50% | 50% | 50% | 50% | 50/150 | Child Only | $1,000 | $1,000 | MAC |
| P5300 | 100% | 80% | 80% | 80% | 50% | 50% | 50/150 | Child Only | $2,500 | $1,000 | 90% |
Underwriting
Dental Dual Option Guidelines
HMO/PPO
- Minimum of 5 eligible employees, 3 enrolling.
- Normal participation guidelines apply based on whether the group is voluntary or contributory, while meeting the minimum of 3 enrolled.
- A minimum of 10 eligible employees and 8 enrolled is required between the two options when a PPO plan is offered that includes orthodontic services.
PPO/PPO
- Minimum of 10 eligible employees, 10 enrolling.
- Normal participation guidelines apply based on whether the group is voluntary or contributory, while meeting the minimum of 10 enrolled.
- A minimum of 8 enrolled is required on any option that includes orthodontic coverage when a plan with orthodontic and a plan without is sold.
- Combination of plans must be logical, e.g. high and low options.
- Plans must differ by more than just orthodontia on one plan.
HMO/HMO
- Minimum of 5 eligible employees, 3 enrolling.
- Normal participation guidelines apply based on whether the group is voluntary or contributory, while meeting the minimum of 3 enrolled.
- Combination of plans must be logical, e.g. high and low options. Target differential 30%
Enrollment Guidelines
What paperwork should we submit for a stand alone dental, vision, life or disability plan?
- Signed group application
- Signed member enrollment form for all eligible employees (including those waiving coverage; waiver forms are not required for voluntary plans)
OR
- Enrollment spreadsheet (waivers are not required)
- Plus one of the following:
- Prior carrier bill (showing the client has had recent medical or ancillary coverage with any carrier) OR
- Current Payroll OR
- Quarterly Wage and Tax Statement
AND
- A binder check equal to the first month’s premium made payable to UnitedHealthcare (A binder check is not required for voluntary case submissions.)
- A copy of the proposal or rate sheet
-
Dental cases: If the group requests to waive the dental waiting period for initial enrollees on a 12 month wait plan, the group submission should also include:
- A Certificate of Coverage (COC) or Summary Plan Description (SPD)
Supplemental Life & Disability cases: A supplemental employer and employee form is required.
Life cases: An Evidence of Insurability (EOI) Form is required if the life benefit is above the Guarantee Issue (GI) amount:
Eligible Employees
Guarantee Issue Amount
2 to 5 eligible employees
$25,000
6 to 19 eligible employees
$50,000
20 to 50 eligible employees
$100,000
51 to 99 eligible employees
$175,000
Send to our office:
Health Plans Online, Inc.
31194 La Baya Dr. Ste. 201
Westlake Village, CA 91362
Submission Timeline:
It is ideal to submit all completed forms two weeks before the requested effective date to provide ample time for the carrier to underwrite and provide a group number.