Basic Plan
Features of this plan include:
- 100% coverage - of allowable charge (AC) for two preventive visits per year
- Annual deductible of $25 per individual for non-preventive services
- 50% of AC for covered general and major restorations, after deductible
- $1,000 annual maximum benefit per covered member
- No orthodontia coverage
- 80%, no deductible for oral surgery; does not apply to annual maximum benefit
Enhanced Plan
Features of this plan include:
- 100% coverage - of allowable charge (AC) for two preventive visits per year
- Annual deductible of $50 per individual for non-preventive services
- 80% of AC for covered general services, after deductible
- 50% of AC for covered major restorations, after deductible
- $2,000 annual maximum benefit per covered member
- $50 lifetime deductible and 50% of AC for orthodontia coverage to $1,500 lifetime maximum per covered member. Does not apply to plan maximum.
- 80%, no deductible for oral surgery; does not apply to annual maximum benefit