UHC DENTAL PLAN Services UHC High Plan UHC Low Plan Network In-Network Out-of-Network In-Network Out-of-Network ▪ United Healthcare $50 / $150 $50 / $150 $50 / $150 $50 / $150 Deductible (Waived for (Waived for (Waived for (Waived for Plan Preventative) Preventative) Preventative) Preventative) ▪ 5/1/2021 – 4/30/2022 Preventative Services 100% 100% 100% 100% Provider Search www.myuhc.com Basic Services 80% 80% 80% 80% Additional Information ▪ PPO Summary Major Services 50% 50% 0% 0% Annual Maximum $2,000 $2,000 $1,000 $1,000 17 17