|
Annual Deductible/Individual
|
$0
|
N/A
|
|
Annual Deductible/Family
|
$0
|
N/A
|
|
Annual Plan Maximum
|
N/A
|
N/A
|
|
Lifetime Orthodontia Plan Maximum
|
N/A
|
N/A
|
|
Diagnostic and Preventive Services
|
copays vary between $0 and $165 depending on service
|
N/A
|
|
Major Services
|
copays vary between $0 and $240 depending on service
|
N/A
|
|
Basic Services
|
copays vary between $0 and $280 depending on service
|
N/A
|
|
Orthodontia Services
|
copays vary between $25 and $1900 depending on service
|
N/A
|
|
Ortho Dependent Children
|
$1,700
|
N/A
|
|
Ortho Adults (and Covered Full-Time Students, if Eligible)
|
$1,900
|
N/A
|
