In-Network Deductible (Single/Family)
$25/$50
In-Network Annual Maximum
$5,000 per person
PPO Plus Premier Enhanced Covered Services
Preventive Services: 100% in-network
Basic Services: 80% in-network
Endodontics: 80% in-network
Oral Surgery: 80% in-network
Major Services: 60% in-network
Prosthodontics: 60% in-network
Orthodontics: N/A
