DENTAL

	In-Network	Out-of-Network
Deductible	$50 per person / $150 family maximum
Annual Maximum Benefit	$1,500 per person
Orthodontia Lifetime Maximum	Not Covered
Type A: Preventive Care	100%
Type B: Basic Care	20% after deductible	50% after deductible
Type C: Major Care	50% after deductible	40% after deductible
Orthodontia	Not Covered

800-541-7846