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reasonable and customary charge, after deductible; Type C Services are covered at 50% of the
reasonable and customary charge, after deductible. Orthodontic Services covered at 50% of the
customary and reasonable charge, and subject to the same payment schedule as in-network
orthodontia.
The annual deductible for Type B and C Services is $50 per individual, up to a maximum of $150
per family. Type A, B, and C Services are subject to a $3,000 annual limit. Orthodontic Services
are only covered for children up to age 19 and are subject to a $3,000 lifetime limit per person.
Other benefit limitations may apply.
Benefits may vary for residents of certain states. Please refer to the benefits booklet for more
information.
COBRA Contact:
Human Resources
1271 Avenue of the Americas
New York, NY 10020
Telephone: 212-931-7852
DB1/ 116795505.8
