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Preventive
100% †
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Basic
100% †
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Major
85% †
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Orthodontic Maximum (Lifetime)
$1,800 Up to age 19, $1,200 Adults 19+ Comprehensive Case Only
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Primary Care Maximum
$3,000.00
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Specialty Care Maximum
$1000.00
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Total Annual Maximum
$4,000.00
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Benefit Summary
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Provider Directory
† PERCENTAGES are APPROXIMATE, see Benefit Summary.