












|
|
Silver
Plan |
Gold
Co-Pay Plan |
Platinum
Plan |
| Option
1 |
|
Option
2 |
|
| Type of Plan |
A fee-for-service discount
plan |
Insured PPO |
Insured PPO |
|
Insured PPO |
| Type of Network |
In-Network Benefits Only |
In-Network Benefits Only |
In or Out-of-Network
Benefits |
In or Out-of-Network
Benefits |
| Preventive
Routine exams, cleaning, and x-rays |
Up to 90%
Fee Reduction |
100%
Deductible Applies |
100%
Deductible Applies |
100%
Deductible Applies |
| Basic
Fillings and oral surgery |
Up to 60%
Fee Reduction |
Up to 70% Coverage |
70%
Deductible Applies |
80%
Deductible Applies |
| Major
Crowns, bridges, dentures, and endodontics |
Up to 50%
Fee Reduction |
Up to 50% Coverage |
50%
Deductible Applies
($500 year max)** |
50%
Deductible Applies
($500 year max)** |
| Orthodontics |
20% Discount* |
20% Discount* |
20% Discount*
(In-Network) |
$500 per year $1,000 lifetime maximum
|
| Maximum Benefit |
Unlimited |
Unlimited |
$1,000 per year** |
$1,000 per year** |
| Deductible |
$0 |
$25/$75 |
$75/$225 |
$50/$150 |
| Waiting Periods |
|
|
|
|
| Basic |
None |
6 Months |
6 Months |
6 Months |
| Major |
None |
12 Months |
18 Months |
15 Months |
| Othodontic |
None |
None |
None |
24 Months |
|
| Rates
(Monthly) |
Single |
$8.00 |
$19.00 |
$26.00 |
|
$33.00 |
Subscriber+1 |
$11.00 |
$35.00 |
$48.00 |
|
$61.00 |
Subscriber+2 |
$15.00 |
$43.00 |
$62.00 |
|
$80.00 |
Subscriber+3 |
$15.00 |
$51.00 |
$76.00 |
|
$99.00 |
Subscriber+4 |
$15.00 |
$59.00 |
$90.00 |
|
$118.00 |
Subscriber+5 |
$15.00 |
$67.00 |
$104.00 |
|
$137.00 |
Subscriber+6 or
more |
$15.00 |
$75.00 |
$118.00 |
|
$156.00 |
|
Additional Plan options are available to view Here.
*Discount only - no benefit
will be paid.
**Platinum - $1,000 annual maximum, of which $500 can be used
for Major Services.
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Revised:February 23, 2010-- This
website is for comparison and informational purposes only. Actual
premiums and coverage availability may vary due to age, sex, family
size, zip code, health history, and tobacco use and are subject
to change at any time without notice. All information submitted
is held in strict confidence. See policies and brochures for coverages,
exclusions, restrictions, and limitations. For any Questions, Quotes,
Concerns, or Problems with this Website Please Contact
Us Anyone can quote you a low premium
and tell you how wonderful the plan will be. Remember it costs nothing
more to have an agent. The insurance companies pay me directly ,
and do not charge you more for usng an agent. Therefore, I am a
free source for questions and concerns. If you have learned more
from me than the competition, I hope you will let me be your agent.

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