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2013/14 Dental Benefits Option 2

2013/14 Dental Benefits Option 2. Coverage A: Preventative & Diagnostic Deductible: Zero in and out of network Coinsurance: 20% in network 30% out of network

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2013/14 Dental Benefits Option 2

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  1. 2013/14 Dental Benefits Option 2 • Coverage A: Preventative & Diagnostic Deductible: Zero in and out of network Coinsurance: 20% in network 30% out of network • Coverage B: Maintenance & Simple Restorative; Oral surgery; Periodontic & Endodontic Services Deductible: Zero in network $50 out of network Coinsurance: 20% In network 30% out of network • Coverage C: Complex and Restorative Dentistry Deductible: $25 in network $50 out of network Coinsurance: 50% In network 50% out of network

  2. 2013/14 Dental Benefits Option 4 Coverage A: Preventative & Diagnostic Deductible: Zero in network and out of network Coinsurance: 20% in network 30% out of network Coverage B: Maintenance & Simple Restorative ; Oral Surgery; Periodontic & Endodontic Services Deductible: Zero in network and out of network Coinsurance: 20% in network 30% out of network

  3. 2013/14 Dental Benefits Option 4 Coverage C: Complex Restorative Deductible: Zero in and out of network Coinsurance: 20% in network 30% out of network Coverage D: Orthodontic Dentistry Deductible: Zero in network $25 out of network Coinsurance: 50% in and out of network Contract benefit maximum: $2,000 Per covered family member.

  4. Medical Rates

  5. Dental Rates Option 2

  6. Dental Rates Option 4

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