|
|
|
|
COVERAGE | Personal Dental
Maintenance Plan
| Personal Dental
Major Plan
| Personal Dental
Comprehensive Plan | In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network | Out-of-Network |
Diagnostic/preventive
(Routine check-up) | 100% | 80% | 0% | 0% | 100% | 80% | Sealants | 100% | 80% | 100% | 80% | 100% | 80% | Fillings | 50% - 80% | 50% | 50% - 80% | 50% | 50% - 80% | 50% |
Basic services | 0% | 0% | 50% - 80% | 50% | 50% - 80% | 50% | Surgical services | 0% | 0% | After six months | 50% | 50% | 50% | 50% | Major restorative
(Crowns, bridges, etc.) | 0% | 0% | After twelve months |
50% | 25% | 50% | 25% | Annual deductible
(Per person) | $50 | $75 | $50 | $75 | $50 | $75 | Annual plan maximum
(Per person) | $1,250 | $750 | $1,250 | $750 | $1,250 | $750 |
COVERAGE | Personal Dental
Maintenance Plan
| Personal Dental
Major Plan
| Personal Dental
Comprehensive Plan |
Networks | HealthPartners Dental Group | HealthPartners Dental Group | HealthPartners Dental Group | Premiums for Minnesota Senior Federation Members | $26.06 | $19.64 | $37.69 | Open Access | Open Access | Open Access | $30.86 | $26.00 | $46.21 | Rates effective April 1, 2009 - March 31, 2010.
|
|
|
|
|
|
|
