|
| Annual
Maximum |
$1,000
|
|
| Individual |
$50
|
| Family |
$150
|
| Preventive
Care (Deductible waived) |
100%
|
| Basic Repairs |
80%
|
| Major Repairs |
50%
|
| Please
note that the above benefits are an overview. Exact coverage
and exclusions are available in the summary plan description
booklet. |
Provider Selection
Participants enrolled in the Indemnity plan are always free to obtain
services from the dental care provider of their choice.
Utilization Review
It is the responsibility of the member to ensure that any course
of treatment expected to exceed $250 is submitted for review. This
procedure ensures coverage and outlines exact out-of-pocket expense
for the member.
|
