Page 6 - Tetra Renewal 2020
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The Tetra Corp: July 2020 Dental Analysis
Current Renewal
BCBSM BCBSM
PPO Plus 100/80/50/50 $1000 SG PPO Plus 100/80/50/50 $1,000 SG
Plan Type PPO PPO
Plan Year 2019 2020
In-Network In-Network
Deductible
Couple/Family $50/$75 $50/$75
Individual $25 $25
Class 1 - Preventitive 0% 0%
Class 2 - Basic 20% 20%
Class 3 - Major 50% 50%
Class 4 - Orthodontic 50% 50%
Orthodontic Lifetime Maximum $1,000 $1,000
Annual Maximum $1,000 $1,000
Waiting Period
Provider Network Blue Dental PPO Blue Dental PPO
Effective Date 7/1/2019 7/1/2020
Total Number of Employees 12 12
Monthly Total Dental Premium $947.90 $967.03
Annual Total Dental Premium $11,374.80 $11,604.36
Percentage Change From Current 2.02%
Annual Dollar Change From Current $229.56
Illustrative purposes only. Rates are subject to carrier approval and underwriting.
