- For illustrative purposes only. Actual cost can vary based on care received, provider, geographical area, plan type and other factors. This example is for a full cast predominantly base metal crown (D2791) and assumes the deductible has already been met.
- The negotiated fee is the amount a participating provider contractually agrees to accept as payment in full for covered services. Based on average contracted rate for D2791 in zip code 75218.
- The plan pays the participating provider’s contracted amount less any coinsurance and deductible. The patient is responsible for their deductible and coinsurance.
- Based on the 2022 average billed charges by out-of-network providers in zip code 75218.
- The patient is responsible for the coinsurance, deductible and any balance between the billed amount and allowed amount. For this example, the billed charges were less than the allowed amount, and there is not a balance.
- 2021 Unum Group Annual Report
Self-insured dental claims are administered by Starmount Life Insurance Company, Baton Rouge, LA.
MA residents — The approved Service Area consists of all of Massachusetts EXCEPT Dukes and Nantucket Counties.
A Dental Network Access Plan is available.
THIS IS A LIMITED POLICY. For policies issued in the Commonwealth of Virginia, THIS IS AN EXCEPTED BENEFITS POLICY. IT PROVIDES COVERAGE ONLY FOR THE LIMITED BENEFITS OR SERVICES SPECIFIED IN THE POLICY.
This policy provides DENTAL insurance only.
Unum Dental PPO plans are underwritten by Starmount Life Insurance Company, Baton Rouge, LA. In New York, underwritten by Provident Life and Casualty Insurance Company, Chattanooga, TN.
The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. See the actual policy or your Unum representative for specific provisions and details of availability.
Applicable to policy forms DN-2007, DN-2010, DN-2015, and 20-GDN-POL.
An insurance producer may be in contact with you.
Virtual dentist visits are a preventive service and subject to the policy year maximum benefit.