Quick facts
Annual Deductible (Individual)
$50 per person
Annual Deductible (Family)
$150 per family
Annual Maximum Benefit
$1,500 per person
Diagnostic & Preventive Coverage
100% covered
Orthodontia Coverage
50% coverage
Basic Services Coverage
80% after deductible
Major Services Coverage
50% after deductible
Endodontics (Root Canals) Coverage
80% after deductible
More details (3)
Periodontics (Gum Treatment) Coverage
80% after deductible
Orthodontia Lifetime Maximum
$1,500 per person
Orthodontia Waiting Period
12-month waiting period
Carrier contact
1-800-555-0199 — member services
Group number: 88410
Your member ID card: check the carrier website or app, or ask HR for a copy.
Confirm details with your carrier for current plan information.