Dental Benefits

Calendar Year Deductible

$50 individual
$150 Family

$50 individual
$150 Family

Annual Maximum Per Person

$1,500

$1,500

Preventive Services

100%

80%

Basic Services

80%

60%

Major Services

50%

40%

Orthodontia

N/Not Covered

N/Not Covered

MAX Advantage

Benefits paid for preventive exams, cleanings, fluoride, and x-rays will not be applied to the annual benefit maximum.

Benefits paid for preventive exams, cleanings, fluoride, and x-rays will not be applied to the annual benefit maximum.

Employee

$22.10

Employee + Spouse

$44.54

Employee + Child(ren)

$45.56

Family

$73.41