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