2025_SOB_Dental Advantage_LG 2025_Large Group_Premium IH Important Information about this Plan Document The services above are not all-inclusive – they include only the most common dental procedures in a class or service grouping. UPMC Health Plan encourages, but does not require, Members to seek predetermination for major services, such as crowns and bridges to obtain the most accurate payment estimate. Additional plan information can also be found in the Dental Certificate of Insurance. Pediatric dental services (if applicable) are covered as required under the Affordable Care Act (ACA) for Members enrolled in ACA-compliant group plans. Find eligibility and benefit details in your Pediatric Dental Certificate of Insurance and Pediatric Dental Schedule of Benefits on the UPMC Health Plan member site or call Member Services. UPMC Health Plan is the marketing name used to refer to the following companies, which are licensed to issue individual and group health insurance products or which provide third party administration services for group health plans: UPMC Health Network Inc., UPMC Health Options Inc., UPMC Health Coverage Inc., UPMC Health Plan Inc., UPMC Health Benefits Inc., UPMC for You Inc., Community Care Behavioral Health Organization, and/or UPMC Benefit Management Services Inc. UPMC Health Plan U.S. Steel Tower 600 Grant Street Pittsburgh, PA 15219 www.upmchealthplan.com