Dental Core Plan

Individual annual deductible: $50

Family annual deductible: $150

Preventive Services: 100%

Basic Services: 80%

Major Services: Not Covered

Annual Benefit Maximum: $2,000

Monthly Rates:

EE: $23.10

EE/S: $41.52

EE/C: $52.25

EE/F: $60.62

Dental Buy Up Plan

Individual annual deductible: $50

Family annual deductible: $150

Preventive Services: 100%

Basic Services: 80%

Major Services: 50%

Orthodontic Services: 50% (for children only)

Orthodontic Lifetime Maximum: $1,000

Annual Benefit Maximum: $2,000

Monthly Rates:

EE: $28.05

EE/S: $55.00

EE/C: $67.11

EE/F: $83.00

*Both plans: deductible applies to Basic & Major services only