State Dental Coverage
Unity provides dental benefits to you as part of your coverage under both Unity-UW Health* and Unity Community** plans. To find who administers your dental benefit select your provider network in the chart below.
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UW Health Network Members
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Community and Unity Network Members
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Momentum Insurance Plans, Inc. administers dental benefits for members who have selected a PCP in the UW Health Network. To find out if your dentist is in the Momentum network please access their website
at momentumplans.com/unity or call toll-free 855-729-6569 or locally
608-729-6569. |
Delta Dental administers dental benefits for Community Network members. Through Delta Dental you have access to either the Delta Dental PPO network or the Delta Dental Premier network. To find out if your dentist is a Delta Dental provider please access Delta's website at deltadentalwi.com and select either Delta Dental Premier or Delta Dental PPO as your dental plan or call 800-236-3712. |
Please note: Dental benefits are not available to local government participants.
Dental Benefits Summary
Your Unity dental benefits for Diagnostic, Preventive and Basic Restorative services are:
- Deductible: $0
- Annual Benefit Maximum: $1,000 per member per calendar year for covered Diagnostic, Preventative, and Basic Restorative services
Diagnostic and Preventive Services paid at 100% include:
- Exams twice per calendar year
- Prophylaxis (teeth cleaning) twice per calendar year (periodontal maintenance procedures are not covered)
- X-rays (full mouth x-rays at three year intervals
- Bitewing x-rays (limited to set of 4 films) twice per calendar year
- Fluoride treatments twice per calendar year for dependents up to age 19
- One topical sealant application per tooth for dependents to age 16
- Space maintainers for retaining space when a primary tooth is prematurely lost
Basic Restorative Services paid at 100% include:
- Amalgam (silver) restorations
- Composite (tooth colored) restorations in front teeth
- Extractions (non-surgical)
- Palliative (emergency) treatment of dental pain (minor procedure)
Orthodontics
Orthodontic care for dependent children up to 19 years is covered at 50% of the first $3,000 in covered services for a lifetime maximum payment of $1,500.
Talk to your employer about any supplemental dental insurance that may be available to you for major restorative and periodontal procedures.
You will be issued a separate ID card to use for your Unity dental services. For more information about Unity’s dental benefits, call your dental administrator at the number listed above.
* The hospitals and clinics in Dane County (except for Black Earth and Cambridge) where participating members may receive medical care.
** The hospitals and clinics in the counties of : Adams, Columbia, Crawford, Dodge, Grant, Green, Iowa, Fond du Lac, Jefferson, Juneau, Marquette, Richland, Rock, Sauk, Vernon and Walworth. And the cities of: Black Earth, Blanchardville and Cambridge.
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Unity Health Plans Insurance Corporation. All rights reserved.
