Dental Benefits

Deductible (Individual/Family)

$50/$150

Calendar Year Benefit Max Per Person

$1,000

Diagnostic and Preventive

100%

Basic

80%

Major

50%

Employee

$12.56

Employee + Spouse

$24.86

Employee + Child(ren)

$32.50

Family

$44.80

Deductible (Individual/Family)

$50/$150

Calendar Year Benefit Max Per Person

$1,500

Diagnostic and Preventive

100%

Basic

90%

Major

60%

Orthodontia

50%

Orthodontia Lifetime Maximum

$1,000

Orthodontia Services are for covered depenents up to age 26

Employee Only

$16.40

Employee + Spouse

$32.06

Employee + Child(ren)

$42.50

Family

$58.14