Page 6 - Affiliate Mortgage Services September 2020 Renewal
P. 6
Affiliate Mortgage Services
Dental/Vision Renewal effective 9/1/2020
Current Renewal
Dental Delta Dental Delta Dental
PPO PPO
Rates
Single 5 $39.05 $39.05
Employee + 1 3 $73.01 $73.01
Family 0 $135.07 $135.07
Estimated Monthly Premium $414.28 $414.28
Percentage Change 0.00%
Deductible In-Network In-Network
Individual $50 $50
Family $150 $150
Annual Maximum-Calendar Year
Individual $2,000 $2,000
Family $2,000 per member $2,000 per member
Class 2 80% 80%
Class 3 50% 50%
Current Renewal
Vision EyeMed EyeMed
12/12/12 12/12/12
Rates
Single 6 $8.69 $8.69
Employee + 1 3 $16.51 $16.51
Family 0 $24.25 $24.25
Estimated Monthly Premium $101.67 $101.67
Percentage Change 0.00%
In-Network In-Network
Frequency 12/12/12 12/12/12
Eye Exam $10 $10
Materials/Eyewear $25** $25**
Allowance $200 $200
** EyeMed: $0 Copay on Frames and Contact Lenses-$200 Allowance for each, $25 copay on Lenses if not buying contacts.
Freedom Pass- Pay $0 for any frame at Target Optical locations
