-
Preventive
100%
-
Basic
50%
-
Major
50%
-
Orthodontic Maximum (Lifetime)
$1,800 Up to age 19, $1,500 Adults 19+ Comprehensive Case Only
-
Primary Care Maximum
Unlimited
-
Specialty Care
50%
-
Emerald Provider Directory
-
Benefit Summary
-
Preventive
100%
-
Basic
100%
-
Major
100%
-
Orthodontics (up to age 19)
$0 copayment
-
Orthodontics (adults 19+)
$1250 copayment
-
Primary Care Maximum
Unlimited
-
Specialty Care
85%
-
Emerald Provider Directory
-
Benefit Summary