| |
BENEFITS
INCLUDE: |
-
No-Charge Services
| Oral Exams |
| Routine Semi-Annual
Cleanings |
| X-Rays |
|
- Other Services Including
| Orthodontic Treatment at
Predetermined Copayments |
|
| - No
Deductibles |
| - No Claim Forms |
| -
NoAnnual Dollar Maximum |
| -
Pre-existing Dental Conditions are Covered |
| |
|
| |
PREMIUM
PAYMENT CHOICES |
|
| Economical
Anual Premium |
| Individual |
$108.00 |
| Individual & One Dependent |
$178.20 |
| Family |
$284.04 |
| Automatic
Monthly Bank Draft |
| (Accounts are drafted on the 15th
of each month prior to the month of coverage.) |
| Individual |
$10.00 |
| Individual & One Dependent |
$15.85 |
| Family |
$24.67 |
| THERE IS
A $35.00 ENROLLMENT FEE REQUIRED. |
| |
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you like plan -A-Click
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|
