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Dental Silver Plans

Silver 1 Benefits Child Adult
Deductible Amount $50 $50
Out-of-Pocket (OOP) Maximum $700 Unlimited
Plan Year Maximum None $1,000
What the employee pays after meeting the deductible
Orthodontics Not Covered Not Covered
Preventive and Diagnostic 10% 20%
Minor Restorative Services 25% 50%
Major Restorative Services 50% Not Covered
Waiting Period
Minor Restorative Services None None
Major Restorative Services None None

Silver 2 Benefits Child Adult
Deductible Amount $50 $50
Out-of-Pocket (OOP) Maximum $700 Unlimited
Plan Year Maximum None $1,500
What the employee pays after meeting the deductible
Orthodontics Not Covered Not Covered
Preventive and Diagnostic 10% 0%
Minor Restorative Services 25% 20%
Major Restorative Services 50% 50%
Waiting Period
Minor Restorative Services None None
Major Restorative Services None None

Silver 3 Benefits Child Adult
Deductible Amount $50 $50
Out-of-Pocket (OOP) Maximum $700 Unlimited
Plan Year Maximum None $1,000
What the employee pays after meeting the deductible
Orthodontics 50%, $1000 max 50%, $1000 max
Preventive and Diagnostic 10% 0%
Minor Restorative Services 25% 20%
Major Restorative Services 50% 50%
Waiting Period
Minor Restorative Services None None
Major Restorative Services None None

Silver 4 Benefits Child Adult
Deductible Amount $50 $50
Out-of-Pocket (OOP) Maximum $700 Unlimited
Plan Year Maximum None $1,000
What the employee pays after meeting the deductible
Orthodontics 50%, $1000 max 50%, $1000 max
Preventive and Diagnostic 10% 0%
Minor Restorative Services 25% 20%
Major Restorative Services 50% 50%
Waiting Period
Minor Restorative Services None None
Major Restorative Services None None

Silver V1 Benefits Child Adult
Deductible Amount $20 $50
Out-of-Pocket (OOP) Maximum $700 Unlimited
Plan Year Maximum None $1,500
What the employee pays after meeting the deductible
Orthodontics Not Covered Not Covered
Preventive and Diagnostic 10% 0%
Minor Restorative Services 25% 50%
Major Restorative Services 50% Not Covered
Waiting Period
Minor Restorative Services None None
Major Restorative Services None 12 months

Silver V2 Benefits Child Adult
Deductible Amount $20 $50
Out-of-Pocket (OOP) Maximum $700 Unlimited
Plan Year Maximum None $1,500
What the employee pays after meeting the deductible
Orthodontics Not Covered Not Covered
Preventive and Diagnostic 10% 0%
Minor Restorative Services 25% 20%
Major Restorative Services 50% 50%
Waiting Period
Minor Restorative Services None None
Major Restorative Services None 12 months

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