Laserfiche WebLink
6382 ~ f 'ruF r_risuntia~r 1 <br />- ~ <br />fay. faerd Vi~rage <br />~, <br />Dental Guard IIf Dental Gard Preferred <br />,~ <br />d <br />Dental Maximu~u: $1,500 0 <br />rv <br />$25 Calendar Year Deductible -Two Deductibles per Family ~' <br />FLAN Deductible Waived Lt-Net~-ork Out-of-Network <br />for Pt~eventive Care Coinsurance Coinsurance <br />z <br />Wl Yes 11)0f10Qf6[1 10pfg{-fgp `~ <br />-~ <br />0 <br />z <br />Rate lllonthly <br />Premium <br />38 EE'S EMP'S 17.91 680.58 ~ ~ ~ ~ ? ~~' r ~ -_-, <br />SPO'S d ~ <br />CFIL'S o <br />21 DU'S S&C'S 89.95 62$.45 .~ ~ D ~o ~ ~ ~ ~ ~ ~ rv <br />.53 Total Monthly Premium °' <br />gSr g~ o <br />N <br />Orthodontia is Pal at 5096. Lifetime of $1,000 ~ 3 g4, f l/ "~ <br />21 D[J' 3.47 64.47 <br />~ 1 3 .00 Total Premium w f rtba <br />The above rates are contributory. Tf all employees and dependents participate regardless of cooerage elsewhere and the employer pays the ° <br />entu~e premium, {non-contributory) decrease the rates ten peroent. Rates and premiums are estimates based on the employee data submitted. <br />i~nai rates and premiums will be based on the pion of insnra~aee and actual employee and dependent data taken from enrollment cards. <br />