Page 28 - MPCU Open Enrollment Presentation
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Dental PPO
UCCI
Dental PPO
Network Non-Network
Maximum Benefit $5,000/calendar year
Deductible
- Individual / Family $25 / $75
No Charge No Charge
Preventive Service
Deductible Waived Deductible Waived
Basic Services (after deductible) 10% 20% UCR
Major Services (after deductible) 40% 50% UCR
Orthodontia
- Adult & Children 50%, $2,000 Lifetime Maximum
