Dental Plan
Available with » Personal Health Plan 1 « and » Personal Health Plan 2 «
Plan description
This is a brief summary of the coverage available. Some restrictions may apply. Please speak to your Integra Global representative if you have any questions. The Dental Option can only be purchased in conjunction with medical coverage.
| Plan Features | Dental Plan Option |
|---|---|
| Individual Deductible | $50 |
| Family Deductible | $150 |
| Class I Expenses: Diagnostic - General; Preventive. |
100% |
| Class II Expenses: Restorative (Basic); Endodontics; Periodontics; Prosthodontics - Removable (Maintenance); Prosthodontics - Fixed Bridge (Maintenance); Oral Surgery |
80% |
| Class III Expenses: Restorative (Major); Prosthodontics - Removable (Installation); Prosthodontics - Fixed Bridge (Installation) |
50% |
| Calendar Year Maximum | $1,500 |
| Orthodontic Lifetime Maximum | $1,500 |
Orthodontic and Class III services are available after 6 months of continuous enrollment in the Dental Plan.
Orthodontic services are only available for children under 18 years of age.
Summary of dental rates
| Coverage | Annual Rates | Semi-Annual Rates | Quaterly Rates |
|---|---|---|---|
| Primary Insured | $ 380 | $ 200 | $ 105 |
| Primary plus one | $ 822 | $ 432 | $ 226 |
| Family | $ 1,122 | $ 589 | $ 309 |
| Single Parent with children | $ 705 | $ 370 | $ 194 |
Accidental Death & Dismemberment Option
Available with » Personal Health Plan 1 « and » Personal Health Plan 2 «
Plan description
In the event of an Accidental Death or Dismemberment of the Primary Insured the Insurer pays a lump sum benefit equal to the Principal Sum subject to a Maximum benefit multiplied by a percentage as shown below.
| Plan Features | |
|---|---|
| loss of life | 100% |
| loss of sight on both eyes | 100% |
| loss of both hands or arms | 100% |
| loss of both feet or both legs | 100% |
| loss of one arm and one leg | 100% |
| loss of sight on one eye | 50% |
| loss of one foot or one leg | 50% |
| loss of one hand or arm | 50% |
Summary of AD&D Rates
| Benefit | Annual Rates | Semi-Annual Rates | Quaterly Rates |
|---|---|---|---|
| $ 25,000 | $ 24.00 | $ 12.00 | $ 6.00 |
| $ 50,000 | $ 48.00 | $ 25.00 | $ 13.00 |
| $ 100,000 | $ 96.00 | $ 50.00 | $ 26.00 |
| $ 150,000 | $ 144.00 | $ 75.00 | $ 39.00 |
| $ 250,000 | $ 240.00 | $ 125.00 | $ 65.00 |