| IN NETWORK | OUT OF NETWORK | |
|---|---|---|
| FEATURES | ||
| Deductible | None | Individual: $50 Family: $150 |
| Preventive Care | 100% | 100% |
| Restorative Care | 80% | 70% after deductible |
| Prosthodontic Care | 60% | 60% after deductible |
| Orthodontic Care (Children and Adults) | 50% | 50% after deductible |
| Annual Maximum (Per Person) | $2,000 | $1,500 |
| Orthodontic Lifetime Maximum (Per Person) | $2,500 | $2,500 |