Get to know your benefits. Southwest Carpenters 2019 Dental Benefits. welcometouhc.com/csac

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1 Get to know your benefits. Southwest Carpenters 2019 Dental Benefits welcometouhc.com/csac

2 Knowing your dental benefits helps you make more informed choices. By understanding your dental benefits, you can select the coverage that best fits your needs. In this guide, you'll find information about your options and programs to help make your choices easier. UnitedHealthcare is committed to providing you a smooth and simpler enrollment experience with the support you need. Want more information? Table of Contents BENEFITS PAGE # CA Select Managed Care Plan 3 NV Select Managed Care Plan 4 Dental INO 5 Dental PPO 6 HEALTH & WELLNESS RESOURCES myuhc.com 7 ENROLLMENT Contact Information 8 welcometouhc.com/csac Search for network providers. Learn about your benefits and more. UnitedHealthcare member services Toll-free Number:

3 Benefits Health & Wellness Resources Enrollment California Select Managed Care 1 dental plan Designed for simplicity and lower costs. This plan covers a range of dental services. You can see any general dentist in our network you want. If you choose to see a dentist that is not in our network, you won t receive coverage so it s important to stay in the network. You may see this plan called a Direct Compensation plan. See any network general dentist and save. The plan has a state-wide network of dentists. You ll need a referral from your dentist to see a network specialist. Preventive care is covered 100 percent in the network. Get coverage on hundreds of services. This includes crowns, braces, white fillings and more. No deductibles and annual maximums. You'll pay a lower, fixed copay amount for services and treatments. Search for local dentists. Before you enroll, you can learn more about this plan and see if your dentist is in the network. Visit welcometouhc.com/csac Search the CA Select Managed Care/Direct Compensation network. Extra care during pregnancy. We cover extra dental visits during pregnancy and the first 3 months after birth. Oral cancer screenings. With our dental plan, adults (age 18 and older) get oral cancer screenings as part of your preventive care benefit. Paying for dental care. Annual Maximum Unlimited Know what you'll pay for each service: Copayments Oral Exam $0 Bitewing 2 Films (X-ray) $0 Semi-annual Cleaning $0 Resin (white) Fillings $5 or $10 How your teeth affect your health. Gum disease is a painless disease that causes bacteria and toxins to enter your blood, which may also be connected to: 2 Diabetes Heart disease Pregnancy complications Respiratory conditions Rheumatoid arthritis Crown $20 to $100 Orthodontia adult/child $1,500 FOR MORE INFORMATION, see your official benefit plan documents or visit welcometouhc.com/csac. Toll-Free Habla Español? Podemos ayudar. 1 Benefits for the UnitedHealthcare CA Select Managed Care direct compensation plans are offered by Dental Benefit Providers of California, Inc. UnitedHealthcare Dental is affiliated with UnitedHealthcare. 2 American Dental Association. Mouth Healthy Gum Disease American Dental Association, Web. This information does not replace your official benefit plan documents. Please see your official benefit plan documents for all coverage details, which includes services not covered, limitations and exclusions. See back page for legal statements. 3

4 Benefits Health & Wellness Resources Enrollment Nevada Select Managed Care dental plan Designed for simplicity and lower costs. This is a simpler, lower-cost plan that covers a range of dental services. You can see any dentist in our network you want. If you choose to see a dentist that is not in our network, you will receive an out of network allowance. You may see this plan called a Direct Compensation plan. See any network general dentist you want. The plan has a local network of dentists. You'll need a referral from your dentist to see a network specialist. Preventive care is covered 100 percent in the network. Get coverage on hundreds of services. This includes crowns, braces, white fillings and more. No deductibles and annual maximums. You'll pay a lower, fixed copay amount for services and treatments. Extra care during pregnancy. We cover extra dental visits during pregnancy and the first 3 months after birth. Oral cancer screenings. With our dental plan, adults (age 18 and older) get oral cancer screenings as part of your preventive care benefit. Search for local dentists. Before you enroll, you can learn more about this plan and see if your dentist is in the network. Visit welcometouhc.com/csac. Search the NV Select Managed Care DHMO/NV Pacific Dental network. Paying for dental care. Annual Maximum None Know what you'll pay for each service: Copayments In-Network Out-of-Network Reimbursement Oral Exam $0 $25 Bitewing 2 Films (X-ray) $0 $8 to $18 Semi-annual Cleaning $0 $25 How your teeth affect your health. Gum disease is a painless disease that causes bacteria and toxins to enter your blood, which may also be connected to: 1 Diabetes Heart disease Pregnancy complications Respiratory conditions Rheumatoid arthritis Amalgam (silver) Fillings $5 or $10 $40 to $90 Crown $20 to $100 $160 to $350 Orthodontia adult/child $1,500 $1,500 FOR MORE INFORMATION, see your official benefit plan documents or visit welcometouhc.com/csac. Toll-Free Habla Español? Podemos ayudar. 4 1 American Dental Association. Mouth Healthy Gum Disease American Dental Association, Web. This information does not replace your official benefit plan documents. Please see your official benefit plan documents for all coverage details, which includes services not covered, limitations and exclusions. See back page for all legal statements.

5 Benefits Health & Wellness Resources Enrollment Dental In-Network Only (INO) Plan Giving you freedom and choice. You can see any dentist in our network you want, anywhere across the country. If you see a dentist that is not in our network, you won t receive coverage, so it s important to stay in the network. Get coverage on hundreds of services. Includes crowns, braces, white fillings and more. There s no need to get referrals to see a specialist. Preventive care is covered 100 percent in the network. Care includes routine cleanings, fluoride treatments and bitewing X-rays. Extra care during pregnancy. We cover extra dental visits during pregnancy and the first 3 months after birth. 1 Oral cancer screenings. With our dental plan, adults (age 18 and older) get oral cancer screenings as part of your preventive care benefit. Find a dentist. See any dentist and save by using our network. The plan has a national network of 100,000+ dentists.* Find a network dentist at: welcometouhc.com/csac. *Network size as of January 2018 Paying for dental care. Annual Maximum $5,000 Know what you'll pay for each service: Copayments Oral Exam $0 Bitewing 2 Films (X-ray) $0 Semi-annual Cleaning $0 Resin (white) Fillings $5 or $10 Crown $20 to $100 Coinsurance child/adult Orthodontia 50% to $2,000 FOR MORE INFORMATION, see your official benefit plan documents or visit welcometouhc.com/csac. Toll-Free Habla Español? Podemos ayudar. 1 This service is not available in all states. This information does not replace your official benefit plan documents. Please see your official benefit plan documents for all coverage details, which includes services not covered, limitations and exclusions. See back page for legal statements. 5

6 Benefits Health & Wellness Resources Enrollment Dental PPO Plan Giving you freedom and choice. You can see any dentist you want, anywhere across the country. When you choose a dentist who is part of the plan s large national network, you may receive discounted rates only available to members. Get coverage on hundreds of services. Includes crowns, braces, white fillings and more. There s no need to get referrals to see a specialist. Preventive care is covered 100 percent in the network. Care includes routine cleanings, fluoride treatments and bitewing X-rays. Extra care during pregnancy. We cover extra dental visits during pregnancy and the first 3 months after birth. 1 Oral cancer screenings. With our dental plan, adults (age 18 and older) get oral cancer screenings as part of your preventive care benefit. Find a dentist. See any dentist and save by using our network. The plan has a national network of 100,000+ dentists.* Find a network dentist at: welcometouhc.com/csac. *Network size as of January 2018 Paying for dental care. Annual Maximum DPPO The most the plan will pay in the plan year (per person). $2,000 Lifetime maximum for orthodontic services child/adult This is not an annual maximum. $2,000 Annual Deductible NON- NETWORK NETWORK Before the plan pays for covered services, you'll pay all costs up to: Individual $50 $50 Family $150 $150 Coinsurance for covered services After meeting the deductible, you'll pay this percentage of the cost: Preventive Services (annual exam, X-rays, cleaning) 2 0% 50% Diagnostic Services 0% 50% Basic Dental Services 50% 50% Major Dental Services 50% 50% For residents of TX, AL, MS or LA enrolled in the PPO plan, coinsurance levels will be the same in or out of network. FOR MORE INFORMATION, see your official benefit plan documents or visit welcometouhc.com/csac. Toll-Free Habla Español? Podemos ayudar. 6 1 This service is not available in all states. 2 Preventive services are not subject to a deductible. This information does not replace your official benefit plan documents. Please see your official benefit plan documents for all coverage details, which includes limitations and exclusions. See back page for all legal statements.

7 Benefits Health & Wellness Resources Enrollment Benefits worthy of your favorites bar. Manage your benefits and health care at myuhc.com. Save We ll money suggest when healthier you use activities. the network. Find Get a providers list of Missions, at welcometouhc.com/csac. which are activities help improve and maintain your health. Track claims and expenses. Review your benefit details, claims and expenses at any time. Easily estimate dental costs. You can see what a dental treatment or procedure typically costs, and see what your share of expenses may be. Access your dental ID card. Access dental ID cards for you and your covered family members from your computer or mobile device. myuhc.com makes managing your health plan easier. Sign up when you become a member. 7

8 Benefits Health & Wellness Resources Enrollment Questions? We can help. Toll-free , TTY 711 Habla Español? Podemos ayudar. myuhc.com Notes VISIT welcometouhc.com/csac for more information. 8

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12 Administrative services provided by United HealthCare Services, Inc. or their affiliates. The information in this guide is a general description of your coverage. It is not a contract and does not replace the official benefit coverage documents which may include a Summary of Benefits and Coverage and Certificate of Coverage/Summary Plan Description. If descriptions, percentages, and dollar amounts in this guide differ from what is in the official benefit coverage documents, the official benefits coverage documents prevail. UnitedHealthcare dental coverage underwritten by UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates. Administrative services provided by Dental Benefit Providers, Inc., Dental Benefit Administrative Services (CA only), DBP Services (NY only), United HealthCare Services, Inc. or their affiliates. Plans sold in Texas use policy form number DPOL.06.TX or DPOL.12.TX (Rev. 9/16) and associated COC form numbers DCOC.CER.06 or DCERT.IND.12.TX. Plans sold in Virginia use policy form number DPOL.06.VA with associated COC form number DCOC.CER.06.VA and policy form number DPOL.12.VA with associated COC form number DCOC.CER.12.VA. Network Access Plan information is available for UnitedHealthcare plans in Colorado. UnitedHealthcare has prepared and maintains a network access that describes how the plan monitors the network of providers to ensure that you have access to network providers. The access also has information on the referral processes, compliant procedures, quality programs and emergency services coverage provisions. The network access plan is available at the plan s office: 6465 Greenwood Plaza Blvd, Suite 300, Centennial, CO, 80111, or call Specialty benefits and programs may not be available in all states or for all group sizes. Components subject to change. These policies have exclusions, limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact your UnitedHealthcare sales representative. MT / United HealthCare Services, Inc