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Dental Plans Dental Care Plan Self Family $1,800 $3,600 Annual Maximum: Enjoy coverage up to a specified limit for dental Annual Maximum expenses incurred within a calendar year. Preventative Care: PCP Specialist Access routine check-ups, $1,000 Urgent cleanings, and X-rays at little to no cost, helping prevent dental issues Preventative Care before they arise. Basic Procedures: Coverage for essential Inpatient dental treatments such as fillings $1,000 Outpatient ER and simple extractions, ensuring timely intervention for minor Basic procedures issues. Major Procedures: Benefit from coverage for more extensive Fillings, Repair & Covered ar 80% treatments like root canals, crowns, Maintenance of after deductible and bridges, providing financial crown support for significant dental work. Out-of-Network Coverage: Receive Major procedures partial reimbursement for dental services obtained from providers Bridges & outside of the plan's network, Dentures, ENDO, Covered at 50% offering flexibility in choosing your Single Crown, after deductible Extractions Perio dental care provider. maintenance Out-of-network Deductible $100 / $300 Annual Maximum $1,000 80% after Preventive Care deductible $1,000 lifetime Ortho max 12

Complete Employer Benefits Handbook Template - Google Slides, Powerpoint & PDF - Page 12 Complete Employer Benefits Handbook Template - Google Slides, Powerpoint & PDF Page 11 Page 13