Dental Plans

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IN-NETWORK BENEFIT	LOW PLAN ⊕	HIGH PLAN ⊕
Annual Deductible (Individual/Family)	$0/$0 (waived for preventive)	$0/$0 (waived for preventive)
Annual Plan Maximum	$0.00	$0.00
Preventive Services	Covered at 100%	Covered at 100%
Basic Services	0%	0%
Major Services	0%	0%
Orthodontia	0%	0%
Ortho Lifetime Max	$0.00	$0.00

PER PAY PERIOD

LOW PLAN

HIGH PLAN

Vision Plans

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IN-NETWORK BENEFIT	VISION PLAN ⊕
Exam	$0 Copay
Lenses	$0 Copay
Frames	$0 allowance + 20% off balance over $0
Contact Lenses	100% covered
Medically Necessary	Covered in full
Elective – Conventional	$0 allowance
Frequency of Benefits	Exams: every 12 months Frames and Contacts: every 12 months Or Frames and Lenses: every 12 months

PER PAY PERIOD