E-II. Dental Benefit
Employees and eligible family members will have the choice of PPO or Managed Care. PPO Dental Plan - Member selects an in-network or an out-of-network provider. Managed Care - Member selects a dentist in the provider network.
Plan Design:
| Services | PPO In-Network | PPO Out-of-Network* | Managed Care |
|---|---|---|---|
| Preventive | 80% of PPO rate | 80% of PPO rate | 100% |
| Basic | 80% of PPO rate | 80% of PPO rate | 85-75% |
| Major | 50% of PPO rate | 50% of PPO rate | 70-65% |
| Individual Maximum | |||
| Benefits Limit | $1,500 annually | $1,500 annually | None |
| *Deductible | None | $100 annually | None |
Employee Contributions:
PPO
- Employee: $0
- Employee plus one: 100% contributory at rates determined by plan provider
- Employee plus family: 100% contributory at rates determined by plan provider
Managed Care
- Employee: $0
- Employee plus one: $0
- Employee plus family: $0