Dental Benefits

Annual Maximum Per Person

$1,000

$1,000

$1,000

Deductible (Individual/Family)

$50/$150

$50/$150

$50/$150

Deductible Applies To:

Basic & Major

Basic & Major

Basic & Major

Preventative Services

100%

100%

80%

Basic Services

90%

80%

60%

Major Services

60%

50%

40%

Waiting Period

N/A

N/A

N/A

Orthodontia Services

N/A

N/A

N/A

Dental Rewards

If you have Calendar Year claims between $1 - $300, you will
receive $250 in Rewards to use next year and beyond.
Your accumulated Rewards total is capped at $500.

If you have Calendar Year claims between $1 - $300, you will
receive $250 in Rewards to use next year and beyond.
Your accumulated Rewards total is capped at $500.

If you have Calendar Year claims between $1 - $300, you will
receive $250 in Rewards to use next year and beyond.
Your accumulated Rewards total is capped at $500.

Employee

$21.77

Employee + Spouse

$43.70

Employee + Child(ren)

$45.84

Family

$68.31