Dental and Vision Coverage
Insurance Carrier:
Anthem
Plan Description:
Dental Insurance
Plan Type:
PPO
Employer Contribution:
50% of Employee Only Premium
Calendar Year Deductible
$50 Individual / $150 Family
Calendar Year Maximum
$1,000
Preventive Services
100%
Basic Services
80%
Major Services
50%
Orthodontia (dependent children only)
N/A
Endo/Perio
Major
Percentile
90%
Employee Bi-Weekly Deduction Employee Only
$8.19
Employee + Spouse
$25.24
Employee + Child(ren)
$37.69
Family
$46.22
Insurance Carrier:
Anthem
Plan Description:
Vision Insurance
Employer Contribution:
50% of Employee Only Premium
Vision Exam
$10 Copay
Materials $25 Copay Frequency: Exam / Lenses / Frames / Contact Lenses once every: 12 months / 12 months / 24 months / 12 months Frame Allowance (Retail) $150 Contact Lens Allowance $150 Employee Bi-Weekly Deduction Employee Only $1.38 Employee + Spouse $4.18 Employee + Child(ren) $4.20 Family $7.90
ras medical solution benefits overview 3
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