In-Network Deductible (Individual/Family)
$50/$150
Annual Maximum
$1,000 (Includes Rollover)
Preventive Services: No Charge
Basic Services: 20% after deductible
Major Services: 50% after deductible
Orthodontics: Not Covered
In-Network Deductible (Individual/Family)
$50/$150
Annual Maximum
$1,000 (Includes Rollover)
Preventive Services: No Charge
Basic Services: 20% after deductible
Major Services: 50% after deductible
Orthodontics: Not Covered