- Level 1 - First $50.00 of expenses is applied to the deductible, 3 per family
- Level 2 - 50% of dental expenses up to a maximum benefit of $1,000
*Service Waiting Periods: 3 months on Basic, 6 months on Major, 12 months for Orthodontics.
Service waiting periods waived if the employer pays 100% of employee premiums
Basic: Fillings and Sealants, Space Maintainers, Bleaching and Occlusal Guard
Major: Crowns, Bridges, Dentures, Root Canals, Perio Surgery, and Oral Surgery
4-Tier Employee $28.35
- Employee + 1 $46.80
- Employee + 2 $65.70
- Family $83.55
*Service waiting period begins with your effective date of coverage.