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reasonable and customary charge.
Additional requirements apply (both in- and out-of-network). For example, Type B, Type C and
TMJ Services are covered after an annual $50 individual or $150 family deductible. Type A, Type
B, Type C and TMJ Services are subject to a $2,000 annual limit per person. Orthodontic Services
are only covered for children under age 26 and are subject to a lifetime $50 deductible and $3,000
lifetime limit per person. 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/ 116796385.6
