Dental, Vision & Hearing Select Monthly Rates*
DENTAL COVERAGE $1,000 Maximum Benefit
$0 Deductible
$100 Deductible
Individual + Spouse
Individual + Child(ren)
Individual + Spouse
Individual + Child(ren)
Age Individual
Family
Age Individual
Family
3 - 17
3 - 17
$35.36 $38.11 $48.60
$27.93 $29.15 $37.41 $40.12 $42.42 $45.01
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
$76.21
$91.14 $138.09
$58.31
$71.05 $107.19
$97.19 $133.95 $164.36
$74.82 $104.25 $127.89
$51.79 $103.56 $124.34 $151.30 $54.61 $109.21 $107.70 $126.90 $58.23 $116.46 $110.73 $125.30
$80.24 $84.85 $90.03
$96.95 $117.95
$83.79 $85.69
$98.81 $97.01
$1,500 Maximum Benefit
$0 Deductible
$100 Deductible
Individual + Spouse
Individual + Child(ren)
Individual + Spouse
Individual + Child(ren)
Age Individual
Family
Age Individual
Family
$29.86 $31.09 $40.03 $43.04 $45.68 $48.68
3 - 17
3 - 17
$37.63 $40.51
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
$81.03
$96.95 $146.88
$62.18
$75.88 $114.43
$51.85 $103.70 $142.75 $175.19 $55.40 $110.81 $132.80 $161.60 $58.64 $117.28 $115.56 $136.09 $62.76 $125.53 $119.28 $134.93
$80.07 $111.52 $136.80 $86.09 $103.90 $126.40
$91.35 $97.35
$90.16 $106.29 $92.60 $104.81
$3,000 Maximum Benefit
$0 Deductible
$100 Deductible
Individual + Spouse
Individual + Child(ren)
Individual + Spouse
Individual + Child(ren)
Age Individual
Family
Age Individual
Family
3 - 17
3 - 17
$44.08 $45.56
$34.72 $35.10 $45.52 $49.21
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
$91.11 $111.66 $168.24
$70.19
$87.17 $130.95
$58.71 $117.44 $164.01 $201.18 $63.11 $126.23 $152.66 $185.71 $67.23 $134.45 $132.73 $156.49 $72.33 $144.66 $137.56 $155.68
$91.03 $128.01 $156.99 $98.43 $119.45 $145.30
$52.57 $105.15 $103.86 $122.50 $56.35 $112.70 $107.22 $121.38
$5,000 Maximum Benefit
$0 Deductible
$100 Deductible
Individual + Spouse
Individual + Child(ren)
Individual + Spouse
Individual + Child(ren)
Age Individual
Family
Age Individual
Family
3 - 17
3 - 17
$49.06 $49.84
$37.43 $38.43
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
$99.66 $123.44 $185.54
$76.86
$94.58 $142.37
$64.43 $128.85 $181.09 $222.08 $69.41 $138.83 $168.60 $205.08 $74.13 $148.25 $146.46 $172.78 $79.89 $159.76 $151.98 $172.03
$50.00 $100.00 $139.50 $171.12 $54.19 $108.39 $130.62 $158.93 $58.04 $116.08 $114.43 $134.79 $62.32 $124.65 $118.44 $134.00 * Pricing based off Issue Age
Family rates include up to three children. Additional children are charged the age 3-17 rate per person. Premiums are subject to change. Premium rates based on $1,000, $1,500, $3,000 or $5,000 Policy Year Maximum. Rate based off the age of the eldest/oldest applicant. Benefit exclusions and limitations apply.
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