Benefits and Coverage
| Type | Dental | Dental PLUS |
|---|---|---|
| Preventive Care | 100% after $15 copayment *Two visits per calendar year | 100% after $15 copayment *Two visits per calendar year |
| Oral Surgery/Restorative Care | 50% | 80% |
| Orthodontics | 50% | 50% |
| Orthodontics Lifetime Maximum | (Up to $1,500 per lifetime) | (Up to $2,000 per lifetime) |
| Annual Maximum Benefit | $1,100 per person | $1,500 per person |
Premium
| Type | Dental | Dental PLUS |
|---|---|---|
| Single | $2.50 | $9.50 |
| Two Party | $4.90 | $18.70 |
| Family | $11.30 | $43.30 |