Benefits for 2025 Dental Coverage
SUMMARY OF COVERAGE
In Network
Out-of-Network
Annual Deductible Individual | Family
$50 | $150
Calendar Year Plan Max
$2,500 per person
Preventive Care Benefits
100% deductible waived
100% deductible waived
You pay 20% after deductible You pay 50% after Deductible
Basic Services
100% afterdeductible
You pay 40% after Deductible
Major Services
Orthodontia (Adult / Child)
50% up to $2,000 Lifetime Maximum
Employee Cost Per Pay Period (26)
Dental DPPO Plan
Employee
$12.00
Employee/Spouse
$22.00
Employee/Child(ren)
$32.00
Family
$52.00
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.
2025 Employee Benefit Guide
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