| PRESCRIPTION DRUGS | 80% co-insurance
Maximum: $1,000 | 90% co-insurance
Maximum: $2,000 | 70% co-insurance
Maximum: $1,000 | 70% co-insurance
Maximum: $1,000 |
| DENTAL | Maximum: $500
Exam & Consultation: 80% (100% at a Network Dentist)
Basic & Preventative: 80% (100% at a Network Dentist)
Minor Restorative: 60% (80% at a Network Dentist)
Extractions & Oral Surgery: 70% (90% at a Network Dentist)
Major Restorative: 10% (30% at a Network Dentist) | Maximum: $400
Exam & Consultation: 60% (80% at a Network Dentist)
Basic & Preventative: 60% (80% at a Network Dentist)
Minor Restorative: 50% (70% at a Network Dentist)
Extractions & Oral Surgery: 50% (70% at a Network Dentist)
Major Restorative: 10% (30% at a Network Dentist) | Maximum: $800
Exam & Consultation: 90% (100% at a Network Dentist)
Basic & Preventative: 90% (100% at a Network Dentist)
Minor Restorative: 85% (100% at a Network Dentist)
Extractions & Oral Surgery: 90% (100% at a Network Dentist)
Major Restorative: 20% (40% at a Network Dentist) | Maximum: $500
Exam & Consultation: 80% (100% at a Network Dentist)
Basic & Preventative: 80% (100% at a Network Dentist)
Minor Restorative: 60% (80% at a Network Dentist)
Extractions & Oral Surgery: 70% (90% at a Network Dentist)
Major Restorative: 10% (30% at a Network Dentist) |
| EXTENDED HEALTH | Paramedical Practitioners: 80%
Maximum: $300 | Paramedical Practitioners: 80%
Maximum: $300 | Paramedical Practitioners: 80%
Maximum: $300 | Paramedical Practitioners: 90%
Maximum: $400 |
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