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
$28.29 $30.49 $38.88 $41.43 $43.69 $46.58
$25.98 $27.12 $34.80 $37.32 $39.46 $41.87
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
$60.97
$72.91 $110.47
$54.24 $69.60 $74.64 $78.93 $83.75
$66.09
$99.71
$77.75 $107.16 $131.49
$96.98 $118.97 $90.19 $109.72
$82.85 $87.37 $93.17
$99.47 $121.04 $86.16 $101.52 $88.58 $100.24
$77.94 $79.71
$91.92 $90.24
$1,500 Maximum Benefit
$0 Deductible
$100 Deductible
Individual + Spouse**
Individual + Child(ren)
Individual + Spouse**
Individual + Child(ren)
Age Individual
Family
Age Individual
Family
$27.78 $28.92 $37.24 $40.04 $42.49 $45.28
3 - 17
3 - 17
$30.10 $32.41 $41.48 $44.32 $46.91
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
$64.82
$77.56 $117.50
$57.84
$70.59 $106.45
$74.48 $103.74 $127.26
$82.96 $114.20 $140.15 $88.65 $106.24 $129.28
$80.08 $84.98 $90.56
$96.65 $117.58
$93.82
$92.45 $108.87
$83.87 $86.14
$98.87 $97.50
$50.21 $100.42 $95.42 $107.94
$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
$35.26 $36.45 $46.97
$32.30 $32.65 $42.34 $45.78 $48.90
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
$72.89
$89.33 $134.59
$65.29
$81.09 $121.81
$93.95 $131.21 $160.94
$84.68 $119.08 $146.04 $91.56 $111.12 $135.16
$50.49 $100.98 $122.13 $148.57 $53.78 $107.56 $106.18 $125.19 $57.86 $115.73 $110.05 $124.54
$97.81
$96.61 $113.95
$52.42 $104.84 $99.74 $112.91
$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
$39.25 $39.87
$34.82 $35.75 $46.51
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
18 - 39 40 - 54 55 - 64 65 - 74
$79.73
$98.75 $148.43
$71.50
$87.98 $132.44
$51.54 $103.08 $144.87 $177.66 $55.53 $111.06 $134.88 $164.06 $59.30 $118.60 $117.17 $138.22 $63.91 $127.81 $121.58 $137.62
$93.02 $129.77 $159.18
$50.41 $100.83 $121.51 $147.84 $53.99 $107.98 $106.45 $125.39
75 - 99 $57.97 $115.95 $110.18 $124.65 * Pricing based off Issue Age *** In CA, Spouse or Registered Domestic Partner; In DC, Spouse, Domestic Partner, or Civil Union Partner; In OR, Domestic Partner
Both “Individual + Child(ren)” and “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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