| Calendar Year Maximum |
$1,500 per person |
| |
You pay: |
Annual Deductible Individual/Family |
$0 / $0 |
| Preventive Services |
Covered in full |
Basic & Restorative Services (e.g., fillings, extractions, root canals) |
30%* |
Major Services (e.g., dentures, crowns, bridges) |
50%* |
| Orthodontia Services |
Plan pays up to the lifetime maximum of $1,000 paid 25% initially, remaining 75% paid in equal monthly payments over the term of the Treatment Plan, not to exceed thirty-six (36) months |