| CORE PLAN | ENHANCED PLAN | |||
|---|---|---|---|---|
| PPO PROVIDERS | PREMIER OR OUT-OF-NETWORK PROVIDERS |
PPO PROVIDERS | PREMIER OR OUT-OF-NETWORK PROVIDERS |
|
| Annual Deductible | $100 individual ; $300 family | $50 individual ; $150 family | ||
| Calendar Year Maximum Benefit |
$1,500 | $1,000 | $2,000 | $1,500 |
| Preventive Services | Covered at 100% (no deductible) | |||
| Basic Services | You pay 20% | You pay 40% | You pay 10% | You pay 30% |
| Major Services | You pay 50% | You pay 50% | ||
| Orthodontia | Not covered | You pay 50% (no deductible) | ||
| Lifetime Orthodontia Maximum Benefit |
Not applicable | $3,000 | ||