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- Coverage effective 1st day of month following 90 day initial employment period.
- Must use participating dentist for best benefit
| Plan A |
|
|
| Delta Par |
Non-Par |
| Preventive Services |
80% U & C |
70% U & C |
| Minor Restorative |
50% U & C |
40% U & C |
Major Restorative
(12 mos. wait) |
50% U & C |
40% U & C |
| Plan B |
|
|
| Delta Par |
Non-Par |
| Preventive Services |
100% U & C |
80% U & C |
| Minor Restorative |
80% U & C |
50% U & C |
Major Restorative
(12 mos. wait) |
50% U & C |
50% U & C |
- Participating dentists accept what plan pays.
- For non-participating dentist, employee pays balance of charges after plan pays.
- $50 deductible (does not apply to preventive services)
- Maximum benefit per covered person - $1000 per year
| Premium |
Monthly – full premium deducted on second paycheck of the month |
| Plan A |
Plan B |
| Single |
$16.87 |
$20.97 |
| Single plus one |
$33.71 |
$41.93 |
| Single plus two or more |
$52.42 |
$65.19 |