| Dental PPO Value 75 |
$15 routine exam |
None |
$1,000 per member per benefit period |
| Dental PPO Basic |
None |
$50 per member $150 per family |
$1,500 per member per benefit period |
| Dental PPO Classic 1500 |
None |
$50 per member $150 per family |
$1,500 per member per benefit period |
| Dental PPO Classic 2000 |
None |
$50 per member $150 per family |
$2,000 per member per benefit period |
| Dental PPO Choice 1500 |
None |
$50 per member $150 per family |
$1,500 per member per benefit period |
| Dental PPO Choice 2000 |
None |
$50 per member $150 per family |
$2,000 per member per benefit period |
| Dental PPO Plus 1500 |
None |
$50 per member $150 per family |
$1,500 per member per benefit period |
| Dental PPO Plus 2000 |
None |
$50 per member $150 per family |
$2,000 per member per benefit period |
| Dental EPO Choice copay Essential |
None |
$25 per member $75 per family |
$2,000 per member per benefit period |