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OBM Voluntary Specialty Option

OBMSM Voluntary Specialty Option

The OBM Voluntary Specialty Option is a medium priced plan with fully insured dental and vision components - in addition to an Employee Assistance Program, WorkLife services, and health discounts available on a voluntary basis. Please see below for a list of some of the benefits and services that are included.

DENTAL
In-Network Out-of-Network
(MAC)*
Network National Options PPO 20
Coinsurance
Preventive/Basic/Major 100%/80%/50% 80%/60%/50%
Annual Maximum $1000 ($1500 Option) $1000 ($1500 Option)
Deductible (Single/Family) $50/$150 $50/$150
Preventive Care (teeth cleaning and x-rays) 100% 80%
Minor Restorations 80% 60%
Endodontics, Periodontics and Oral Surgery 50% 50%
Major Care (crowns, bridges and dentures) 50% 50%
Orthodontia (optional) Covered 50%; $1000 lifetime maximum. 10 enrolled Covered 50%; $1000 lifetime maximum. 10 enrolled
Waiting Periods (Major Care and Orthodontia) 12 months for CT, NJ; 6 months for NY 12 months for CT, NJ; 6 months for NY
VISION
In-Network Out-of-Network
Eye Exam (every 12 months) $20 copayment Up to a $20 reimbursement
Materials A $50 materials copayment covers lenses and frames combined or contact lenses.  
Frames (every 24 months) $70 retail frame allowance applied to the cost of the frames, plus 30% discount off frame cost above the allowance at participating network locations. (Not all providers may offer this discount. Please contact your provider to see if they participate.) Up to a $25 reimbursement
Lenses (every 12 months) Standard lenses included in $50 copayment. Up to a $20 - $40 reimbursement
Contacts (every 12 months) Selective contacts included in $50 copayment. Up to a $55 allowance

Employee Assistance Program with WorkLife Services
Support services that offer unlimited telephone consultation, personalized referrals, online resources and services, and educational resources on a wide variety of subjects, including Child/Parenting Support Services, Adult/Elder Support Services, Chronic Condition Support Services and much more.

Health Discounts
A discount program offering savings of 5% to 50% on health-related products and services:

  • Vision (eye exams, LASIK eye surgery, optical products) 5%-50%
  • Dental (general dental, cosmetic dentistry, orthodontia) 10%-35%
  • Alternative Medicine (chiropractic, massage therapy, acupuncture) 20%
  • Wellness (fitness, smoking cessation, weight management, nutrition) 10%-50%
  • Long Term Care (home health care, DME, hospice) 5%-30%
  • Hearing (testing and hearing devices) 10%-20%
  • Infertility (In-vitro fertilization, reproductive endocrinology) 5%-20%

 

* Out-of-network benefits are paid based on UnitedHealthcare Dental's Maximum Allowable Charge (MAC) schedule.

Please note: This is a sample summary provided for informational purposes only. Coverage is subject to the terms and conditions of the Member Certificate or other applicable Member benefit information.