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Dental Dental coverage
Dental Benefits provided by
[Carrier] .
We partner with [Carrier] to offer you and your family members dental
insurance. Visit www.[Carrier].com to ind in-network providers and
access a variety of online tools and programs.
Dental Beneits At-a-Glance
Low Option High Option
Deductible Single: [X] Single: [X]
Family: [X] Family: [X]
Annual Maximum [X] [X]
Preventive Care Covered at 100% Covered at 100%
Basic Care Covered at 80%, after Covered at 90%, after
deductible deductible
Major Care Covered at 50%, after Covered at 60%, after
deductible deductible
Orthodontia
Coinsurance Not covered Covered at 50%, after
deductible
Lifetime Maximum Not covered [X]
Beneit Applies To Adults and children Adults and children
Dental
Low Plan High Plan
Bi-weekly Bi-weekly
Employee Only $ $
Employee and Spouse $ $
Employee and Child(ren) $ $
Employee and Family $ $
[Client Name] 9
Dental Benefits provided by
[Carrier] .
We partner with [Carrier] to offer you and your family members dental
insurance. Visit www.[Carrier].com to ind in-network providers and
access a variety of online tools and programs.
Dental Beneits At-a-Glance
Low Option High Option
Deductible Single: [X] Single: [X]
Family: [X] Family: [X]
Annual Maximum [X] [X]
Preventive Care Covered at 100% Covered at 100%
Basic Care Covered at 80%, after Covered at 90%, after
deductible deductible
Major Care Covered at 50%, after Covered at 60%, after
deductible deductible
Orthodontia
Coinsurance Not covered Covered at 50%, after
deductible
Lifetime Maximum Not covered [X]
Beneit Applies To Adults and children Adults and children
Dental
Low Plan High Plan
Bi-weekly Bi-weekly
Employee Only $ $
Employee and Spouse $ $
Employee and Child(ren) $ $
Employee and Family $ $
[Client Name] 9
