Quick facts
Annual deductible (individual)
$50 per person
Annual deductible (family)
$150 per family
Annual maximum benefit
$1,500 per person
Diagnostic & Preventive Services
100% covered
Orthodontia (adults and children)
50% coverage
Basic Services (fillings, simple extractions)
80% after deductible
Major Services (crowns, bridges, dentures)
50% after deductible
Endodontics (root canals)
80% after deductible
More details (3)
Periodontics (gum treatment)
80% after deductible
Lifetime Orthodontia Maximum
$1,500 per person
Orthodontia Waiting Period
12-month waiting period
Carrier contact
1-800-555-0199 — member services
Group number: 88410
Your member ID card: check the carrier website or app, or ask HR for a copy.
Confirm details with your carrier for current plan information.