Specialty benefits disclaimers

Specialty benefits and programs may not be available in all states or for all group sizes. Components are subject to change. These policies have exclusions, limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact your UnitedHealthcare sales representative.

Dental

Specialty benefits and programs may not be available in all states or for all group sizes. Components are subject to change. These policies have exclusions, limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact your UnitedHealthcare sales representative.

PPO

UnitedHealthcare dental coverage underwritten by UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates. Administrative services provided by Dental Benefit Providers, Inc., Dental Benefit Administrative Services (CA only), DBP Services (NY only), United HealthCare Services, Inc. or their affiliates. Plans sold in Texas use policy form number DPOL.06.TX and associated COC form number DCOC.CER.06. Plans sold in Virginia use policy form number DPOL.06.VA and associated COC form number DCOC.CER.06.VA.

INO

UnitedHealthcare dental coverage underwritten by UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates. Administrative services provided by Dental Benefit Providers, Inc., Dental Benefit Administrative Services (CA only), DBP Services (NY only), United HealthCare Services, Inc. or their affiliates. Plans sold in Virginia use policy form number DPOL.06.VA and associated COC form number DCOC.CER.06.VA.

Gateway

UnitedHealthcare dental coverage underwritten by UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates. Administrative services provided by Dental Benefit Providers, Inc., Dental Benefit Administrative Services (CA only), DBP Services (NY only), United HealthCare Services, Inc. or their affiliates. Plans sold in Texas use policy form number DPOL.06.TX and associated COC form number DCOC.CER.06. Plans sold in Virginia use policy form number DPOL.06.VA and associated COC form number DCOC.CER.06.VA.

Indemnity

UnitedHealthcare dental coverage underwritten by UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates. Administrative services provided by Dental Benefit Providers, Inc., Dental Benefit Administrative Services (CA only), DBP Services (NY only), United HealthCare Services, Inc. or their affiliates. Plans sold in Texas use policy form number DPOL.06.TX and associated COC form number DCOC.CER.06. Plans sold in Virginia use policy form number DPOL.06.VA and associated COC form number DCOC.CER.06.VA.

Select Managed Care/DHMO

Benefits for the UnitedHealthcare dental DHMO plans are provided by or through the following UnitedHealth Group companies: Nevada Pacific Dental, National Pacific Dental, Inc. and Dental Benefit Providers of Illinois, Inc. Plans sold in Texas use contract form number DHMO.CNT.11.TX and associated EOC form number DHMO.EOC.11.TX.

The New York Select Managed Care Plan is underwritten by UnitedHealthcare Insurance Company of New York located in Islandia, New York. Administrative services provided by DBP Services.

The Select DHMO plan is underwritten by Dominion Dental Services, Inc. Dominion is licensed as a Limited Health Care Services HMO in Virginia, Pennsylvania and a Dental Plan Organization in Maryland and Delaware.

* Benefits for the UnitedHealthcare Dental DHMO/Direct Compensation plans are offered by Dental Benefit Providers of California, Inc. UnitedHealthcare Dental is affiliated with UnitedHealthcare.

CA Select Managed Care DHMO

The California Select Managed Care DHMO plan from UnitedHealthcare Dental*

* Benefits for the UnitedHealthcare Dental DHMO/Direct Compensation plans are offered by Dental Benefit Providers of California, Inc. UnitedHealthcare Dental is affiliated with UnitedHealthcare.

Benefits for the Pacific Union Dental DHMO plans are offered by Dental Benefit Providers of California, Inc.

CA Select Managed Care Direct Compensation

The California Select Managed Care DHMO/Direct Compensation plan from UnitedHealthcare Dental*

* Benefits for the UnitedHealthcare Dental DHMO/Direct Compensation plans are offered by Dental Benefit Providers of California, Inc. UnitedHealthcare Dental is affiliated with UnitedHealthcare.

NV Select Managed Care Direct Compensation

Benefits for the UnitedHealthcare dental DHMO / Direct Compensation plans are offered by Nevada Pacific Dental.

Mid-Atlantic/Dominion

PPO – UnitedHealthcare dental coverage underwritten by UnitedHealthcare Insurance Company, located in Hartford, Connecticut, or its affiliates. Administrative services provided by Dental Benefit Providers, Inc., United HealthCare Services, Inc. or their affiliates.

DHMO – The Select DHMO plan is underwritten by Dominion Dental Services, Inc. Dominion is licensed as a Limited Health Care Services HMO in Virginia, Pennsylvania and a Dental Plan Organization in Maryland and Delaware.

TX Select Managed Care DHMO

Benefits for the UnitedHealthcare dental DHMO plans are offered by National Pacific Dental, Inc. National Pacific Dental, Inc. is wholly owned by Dental Benefit Providers, Inc., a UnitedHealth Group company. Plans sold in Texas use contract form number DHMO.CNT.11.TX and associated EOC form number DHMO.EOC.11.TX.

NY Select Managed Care

The New York Select Managed Care Plan is underwritten by UnitedHealthcare Insurance Company of New York located in Islandia, New York. Administrative services provided by DBP Services.

Solstice (FL) DHMO

Offered by Solstice Benefits, Inc. a Licensed Prepaid Limited Health Service Organization; Chapter 636 F. S., and administered by Dental Benefit Providers, Inc.

Health Net - HMO

Health Net Dental HMO products are offered and provided by Dental Benefit Providers of California, Inc. (“DBP”). The obligations of DBP are not the obligations of or guaranteed by Health Net, Inc. or its affiliates.

Health Net – PPO (CA) and Indemnity

Health Net Dental PPO and indemnity products are underwritten by Unimerica Life Insurance Company. The obligations of Unimerica Life Insurance Company are not the obligations of or guaranteed by Health Net, Inc. or its affiliates.

Health Net – PPO (AZ) and Indemnity

Health Net Dental PPO and indemnity products are underwritten by Unimerica Insurance Company. The obligations of Unimerica Insurance Company are not the obligations of or guaranteed by Health Net, Inc. or its affiliates.

Health Net – (PPO - CA; DHMO - CA)

Health Net Dental HMO products are offered and provided by Dental Benefit Providers of California, Inc. (“DBP”) and Health Net Dental PPO and indemnity products are underwritten by Unimerica Life Insurance Company. The obligations of DBP and Unimerica Life Insurance Company are not the obligations of or guaranteed by Health Net, Inc. or its affiliates.

Health Net – (PPO - AZ; DHMO - CA)

Health Net Dental HMO products are provided by Dental Benefit Providers of California, Inc. (“DBP”) and Health Net Dental PPO and indemnity products are underwritten by Unimerica Insurance Company. The obligations of DBP and Unimerica Insurance Company are not the obligations of or guaranteed by Health Net, Inc. or its affiliates.

Consumer Max Multiplier, Flex Appeal, Flex Appeal Enhanced

UnitedHealthcare dental coverage underwritten by UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates. Administrative services provided by Dental Benefit Providers, Inc., Dental Benefit Administrative Services (CA only), DBP Services (NY only), United HealthCare Services, Inc. or their affiliates. Plans sold in Texas use policy form number DPOL.06.TX and associated COC form number DCOC.CER.06. Plans sold in Virginia use policy form number DPOL.06.VA and associated COC form number DCOC.CER.06.VA.

Vision

UnitedHealthcare vision coverage provided by or through UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates. Administrative services provided by Spectera, Inc., United HealthCare Services, Inc. or their affiliates. Plans sold in Texas use policy form number VPOL.06.TX or VPOL.13.TX and associated COC form number VCOC.INT.06.TX or VCOC.CER.13.TX. Plans sold in Virginia use policy form number VPOL.06.VA or VPOL.13.VA and associated COC form number VCOC.INT.06.VA or VCOC.CER.13.VA.

Life

UnitedHealthcare Life products are provided by UnitedHealthcare Insurance Company and certain products in California by Unimerica Life Insurance Company; and in New York by Unimerica Life Insurance Company of New York. In New York, it is provided on Form LASD-POL-LIFE NY (05/03). In Texas, it is provided on Form LASD-POL-TX (05/03) or Form UHCLD-POL 2/2008-TX. In Virginia, it is provided on Form LASD-POL (05/03). UnitedHealthcare Insurance Company is located in Hartford, CT; Unimerica Life Insurance Company is located in Milwaukee, WI; Unimerica Life Insurance Company of New York in New York, NY. Products may vary by state or may not be available in all states.

Disability

UnitedHealthcare Disability products are provided by UnitedHealthcare Insurance Company - and certain products in California by Unimerica Life Insurance Company; and in New York by Unimerica Life Insurance Company of New York. In New York, it is provided on Form LASD-POL-ADD/DIS NY (05/03). In Texas, it is provided on Form LASD-POL-TX (05/03) or Form UHCLD-POL 2/2008-TX. In Virginia, it is provided on Form LASD-POL (05/03). UnitedHealthcare Insurance Company is located in Hartford, CT; Unimerica Life Insurance Company is located in Milwaukee, WI; Unimerica Life Insurance Company of New York in New York, NY. Some products vary by state or may not be available in all states.

Critical Illness Protection

UnitedHealthcare Critical Illness Protection Plan is provided by UnitedHealthcare Insurance Company on Policy Form UHICI-POL-1 et al. In Texas, it is provided on Form UHICI-POL-1, In Virginia, it is provided on Form UHICI-POL-1-VA. In New York, it is provided by Unimerica Life Insurance Company of New York as Specified Disease Coverage on Policy Form UHICI-POL-1-NY. Critical Illness coverage is NOT considered “minimum essential coverage” under the Affordable Care Act and therefore does NOT satisfy the mandate to have health insurance coverage. Failure to have other health insurance coverage may be subject to a tax penalty. Please consult a tax advisor. UnitedHealthcare Insurance Company is located in Hartford, CT; Unimerica Life Insurance Company of New York is located in New York, NY. Some products vary by state or may not be available in all states.

Accident Protection

UnitedHealthcare Accident Protection Plan is provided by UnitedHealthcare Insurance Company on Policy Form UHI-ACC-POL (2018) et al. In Texas, it is provided on Policy Form UHC-ACC-POL-TX (2018), In Virginia, it is provided on Policy Form UHI-ACC-POL-VA (2018). In New York it is provided by Unimerica Life Insurance Company of New York on Policy Form UHCAC-POL-1-NY (01/12). This policy provides accident insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services. The expected benefit ratio for this policy is 65 percent. This ratio is the portion of future premiums that the company expects to return as benefits, when averaged over all people with this policy. UnitedHealthcare Insurance Company is located in Hartford, CT; Unimerica Life Insurance Company of New York is located in New York, NY. Some products vary by state or may not be available in all states.

Hospital Indemnity Protection

UnitedHealthcare Hospital Indemnity product is provided by UnitedHealthcare Insurance Company on Policy Form UHIHIP-POL, et al. and UHIHIP-CERT. In Texas, it is provided on Policy Form UHIHIP-POL-TX, et al. and UHIHIP-CERT-TX, et al. In Virginia, it is provided on Policy Form UHIHIP-POL-VA, et al. and UHIHIP-CERT-VA, et al. In New York, it is provided by Unimerica Life Insurance Company of New York on Policy Form UHIHIP-POL-NY. The product provides a limited benefit for certain hospital indemnity plan benefits. Please note: HOSPITAL INDEMNITY coverage is NOT considered “minimum essential coverage” under the Affordable Care Act and therefore does NOT satisfy the mandate to have health insurance coverage. Failure to have other health insurance coverage may be subject to a tax penalty. Please consult a tax advisor. UnitedHealthcare Insurance Company is located in Hartford, CT; Unimerica Life Insurance Company of New York is located in New York, NY. Some products vary by state or may not be available in all states.

Stop Loss

OptumHealth Stop Loss products are provided by UnitedHealthcare Insurance Company, Unimerica Insurance Company; and in California by Unimerica Life Insurance Company; and in New York by Unimerica Life Insurance Company of New York. UnitedHealthcare Insurance Company is located in Hartford, CT; Unimerica Life Insurance Company in Milwaukee, WI; Unimerica Life Insurance Company of New York in New York, NY. Some products vary by state or may not be available in all states.