| Basics | Basic and Voluntary Dental Features and Benefits |
|---|---|
| Case size | Available to groups of 10 or more eligible employees |
| Rate guarantee period | Up to 2 years depending on group size |
| Deductible options
(per calendar year) | $25 individual / $75 family
$50 individual / $150 family $75 individual / $225 family $100 individual / $300 family |
| Deductible waived | In-network preventative services |
| In-network and Out-of-Network co-insurance options1 | 100/90/50 OR 100/80/50 OR 100/60/50 OR 80/80/50 OR 80/60/50 |
| Limit for reasonable and customary charges | 80th, 85th or 90th percentile |
| Service classes | Diagnostic & preventative: Exams, routine X-rays, cleanings, fluoride treatments and sealant for children (age limitations may apply)
Basic: Fillings, extractions, endodontic services (root canal therapy) and periodontal procedures (treatment of gum disorders) Major: Crowns, dentures and bridges Orthodontia (optional): See benefit below |
| Orthodontic benefit option | Available to children (age limitations may apply)
50% co-insurance Lifetime maximums: up to $1,500 |
| Pre-treatment review | $300 |
1 MAC plans are available (MAC = Maximum Allowable Charge)
