Coverage is available to paid Members of the United Business Association after the effective date listed in your welcome letter following the receipt of the Membership application and the payment of the first month's dues to the United Business Association.

Insurance benefits are underwritten by Renaissance Life & Health Insurance Company of America, Indianapolis, IN and in New York by Renaissance Life & Health Insurance Company of New York, New York, NY. Both companies (“Renaissance”) can be reached at P.O. Box 1596, Indianapolis, IN 46206. There is no ownership affiliation between Renaissance and Gap Dental & Vision. For complete coverage details, please refer to the certificate of insurance.

Annual Deductible: Individual / Family (Deductible waived for Diagnostic & Preventive Services)	$50.00 / $150.00
Annual Maximum Plus Maximum Carryover1	$1,000.00

1 If at least one covered service is paid in a benefit year and the total benefit paid does not exceed $500 in that benefit year, $250 will be added to the next benefit year carryover maximum. This amount will accumulate from one benefit year to the next, but will not exceed $1,000.

Diagnostic & Preventive Services	Basic Dental Services	*Major Dental Services
100%	70%	50%
VIEW SERVICES	VIEW SERVICES	VIEW SERVICES

SAVE ON THE CARE YOU NEED2

For example: A dentist may submit a $950 charge for a crown. With dental insurance, the dentist accepts a reduced fee of $744. That's an immediate savings of $206! Furthermore, having dental insurance means the carrier pays a percentage from the reduced fee so you can see how the advantages of dental coverage can add up quickly.

For an In-Network Dentist:2

Submitted Fee
$950.00

2 The payment example above is for illustrative purposes only. Fees and reimbursements can vary by location and dentist. It does however represent how the payment is determined.

Difference Between In- & Out-of-Network Benefits:

In-Network Benefits

Based on the negotiated contracted dentist fee schedule. Using in-network dentists, the member can save more because the significant contracted discounts will result in less out-of-pocket expenses. By saving, the member will be able to receive more services during the year than if the member sees a non-contracted dentist.

Out-of-Network Benefits

Based on the local UCR charges. By seeing an out-of-network dentist, you have the freedom to choose any dentist and still have the benefits paid at the same coinsurance percentages. However, your annual maximum could be met sooner since the out-of-network dentists don't offer the same contracted discounts.

More than 1 in 5 people said that they had not visited the dentist in the last few years.1

40.2% of adults indicated that they will forgo dental care due to cost.1

1 Stats taken from: Health Policy Institute (ADA American Dental Association) http://ada.org/en/science-research/health-policy-institute/dental-statistics/patients

THIS IS NOT COMPREHENSIVE MAJOR MEDICAL INSURANCE. THIS IS A DENTAL ONLY POLICY.

The information is a limited description of the plan highlights. For more details, limitations, exclusions and definitions, please refer to the Certificate. Insurance benefits are underwritten by Renaissance Life & Health Insurance Company of America, Indianapolis, IN and in New York by Renaissance Life & Health Insurance Company of New York, New York, NY. Both companies (“Renaissance”) can be reached at P.O. Box 1596, Indianapolis, IN 46206. There is no ownership affiliation between Renaissance and Gap Dental & Vision. For complete coverage details, please refer to the certificate of insurance.