
Contact Us:303 North Church Street |
Dental Plan
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Benefit |
In-Network |
Out-of-Network |
Annual Deductible |
$50 per individual up to $150 per family |
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$1,000 per individual |
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Preventive & Diagnostic |
100% No Deductible |
80% No Deductible |
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80% After Deductible |
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50% After Deductible |
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50% After Separate $50 Deductible |
40% After Separate $100 Deductible |
Orthodontia Lifetime Maximum |
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Benefit |
In-Network |
Out-of-Network |
|
$50 per individual up to $150 per family |
|
Calendar Year Max |
$1,000 per individual |
Same |
Preventive & Diagnostic |
100% No Deductible |
Same |
Basic Restorative |
80% After Deductible |
Same |
Major Restorative |
50% After Deductible |
Same |
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50% After Separate $50 Deductible |
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Orthodontia Lifetime Maximum |
$1,000 |
Same |
Disclaimer: Major restorative and orthodontia care are subject to a one year waiting period.