Voluntary Dental Plan Summary
Insured by: Delta Dental
| Low Plan | High Plan | ||
| Deductible | $50 Individual $150 Family | $50 Individual $150 Family | |
| Maximum Annual Benefit | $1,000 | $1,000 | |
| Preventive & Diagnostic | 100%; deductible waived | 100%; deductible waived | |
| Basic | 80% | 80% | |
| Major | Not Covered | 50% (12-month waiting period for new employee) | |
| Orthodontia | Coinsurance | Not Covered | 50% |
| Lifetime Maximum | $1,000 | ||
| Age Limitation | 26 years |
Dental Premiums
| Low Plan Employee Cost Per Pay Period | High Plan Employee Cost Per Pay Period | |
| Employee Only | $9.24 | $18.94 |
| Employee + Spouse | $18.40 | $37.37 |
| Employee + Child(ren) | $33.56 | $48.71 |
| Employee + Family | $42.42 | $67.15 |