Voluntary Dental & Voluntary Vision Plans

2006 Renewal

 

 

 

 

Voluntary PPO Dental (MAC1000V)

 

*    $50 Calendar Year Deductible (Waived for Preventive/PPO provider only)

*    $1000 Calendar Year Maximum Benefit per member

*    Type I Preventive Services Covered at

*    100% PPO Providers Only

*    90% All Other Providers - Schedule

*    Type II Basic Services Covered at

*    80% PPO Providers Only

*    70% All Other Providers - Schedule

*    Type III Major Services Covered at 50%

*    Orthodontia Procedures Included

 

Monthly Premiums:   Employee Only                    $29.26

                                      Employee & Spouse             58.77

                                      Employee & Child(ren)        57.23

                                      Employee & Family               86.73

 

 

Voluntary HMO Dental (PCPV)

 

*    No Deductibles

*    No Charge for Diagnostic Exams and Routine Cleanings

*    Member Copayments for all Covered Services

*    Preventive

*    Prosthetics

*    Prosthodontics

*    Oral Surgery

*    Orthodontics

*    Adjunctive General Services

*    Material Upgrades

*    Cosmetic Dentistry (Elective Services)

 

Monthly Premiums:   Employee Only                    $11.01

                                      Employee & Spouse             17.68

                                      Employee & Child(ren)        16.74

                                      Employee & Family               25.64

 

 

Voluntary HMO Vision (90GE)

 

*    All Covered Services Must be Provided by a Participating Vision Provider

*    No Charge for Vision Acuity Exam

*    No Charge for Office Visits

*    30% Discount on Frames & $35 - $50 per Pair of Lenses (Glass or Plastic)

*    Contact Lenses Covered at Reduced Cost

 

Monthly Premiums:   Employee Only                    $ 7.07

                                      Employee & Spouse           13.29

                                      Employee & Child(ren)      12.21

                                      Employee & Family             20.25

 

 

NOTE:

1.    Voluntary PPO Dental & HMO Vision Plan Rates are Guaranteed to August 1, 2006.

2.    Voluntary HMO Dental Rates are Guaranteed to August 1, 2006.

3.    PPO Dental Plan will require 5 or more enrolled employees in an employer group.

4.    PPO Dental Plan IS available as a dual-choice option with HMO Dental Plan (PPO Dental still requires 5 or more enrolled employees).

 

 

 

 

 

 

 

 

 

 

 

 

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