DENTAL PLAN
SUMMARY OF COVERAGE
Key Features
Humana Dental Plan
Annual Deductible Individual | Family
$50 | $150
$1,500 per person +30% Extended Annual Maximum
Calendar Year Max
$1,500 per member (adult or child)
Orthodontia Lifetime Max
Preventive Care Benefits
No Charge
Basic Services
20% after deductible
Major Services
50% after deductible
50%
Orthodontia
Bi-Weekly Contribution
Employee Only
$6.18
Employee and Spouse
$17.37
Employee and Child
$22.04
Family
$35.62
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DENTAL PLAN I
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