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July 23, 2017

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HEALTH INSURANCE: DENTAL / VISION
Print-friendly PDF of all plans (525k)
DescriptionDENTAL
Benefits
Individual Calendar Year Deductible
Family Calendar Year Deductible

$50 Basic / Major
$150 Basic / Major
Co-Insurance
Preventative: 100% of UCR
Basic: 80% of UCR
Major: 50% of UCR
Orthodontia:
(Under Age 19)
50% of UCR
Maximum Benefit Amount $1,000 per calendar year (Prev/Basic/Maj)
$1,000 lifetime (Orthodontia)
Waiting Period Before Benefits Payable Major Services: after 12 months of coverage
Orthodontia: after 12 months of coverage
DescriptionVISION
Benefits
One eye exam, per person,
in a 12 month period

$50
Frame-type lenses,
per pair in 24 month period

Single vision
Bi-focal
Tri-focal
Lenticular


$50
$60
$70
$80
Frames, per pair,
in a 24 months period
$150
Contact lenses, per pair,
in a 24 months period
$150
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This summary is intended to highlight your healthcare benefits and is not a contract of insurance. Please refer to your Summary Plan Description for a complete explanation of covered services, limitations, exclusions and a description of all terms and conditions of coverage.