Dental Benefits
PPO |
DHMO |
|
|---|---|---|
Type 1 - Preventive Services |
100% |
Member Copayment Schedule |
Type 2 - Basic Services |
80% |
Member Copayment Schedule |
Type 3 - Major Services |
50% |
Member Copayment Schedule |
Type 4 - Orthodontics Services |
N/A |
Member Copayment Schedule |
Calendar Year Deductible |
$50 x 3 |
Member Copayment Schedule |
Maximum Benefit Per Person |
$1,000 |
Member Copayment Schedule |
Dependent Limiting Age |
26 |
26 |
Monthly Rate |
PPO |
DHMO |
|---|---|---|
Employee Only |
$34.46 |
$10.57 |
Employee + 1 |
$66.04 |
$16.99 |
Employee + 2 or More |
$115.70 |
$25.91 |
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