Dental Benefits

Deductible (Individual/Family)

$50 / $150

$50 / $150

Type I - Preventative Services

0%

Deductible

Type II - Basic Services

Deductible then 10%

Deductible then 20%

Type III - Major Services

Deductible then 40%

Deductible then 50%

Type IV - Orthodontia Services

Deductible then 50%

Deductible then 50%

Orthodontia Lifetime Maximum

$1,000 per child up to age 19

$1,000 per child up to age 19

Calendar Year Maximum

$2,000 per person

$2,000 per person

Employee

$0.00

Employee + Spouse

$6.68

Employee + Child(ren)

$15.39

Family

$31.21