Retired Group — State, Local Government, and Education ...

Retired Group -- State, Local Government, and Education

Dental Rates Effective 1/1/2020 to 12/31/2020

PLAN/COVERAGE DESCRIPTION DENTAL EXPENSE PLAN (#398) Single Member & Spouse/Partner Family Parent & Child CIGNA (DPO #305) Single Member & Spouse/Partner Family Parent & Child HEALTHPLEX (DPO #307) Single Member & Spouse/Partner Family Parent & Child HORIZON DENTAL CHOICE (DPO #317) Single Member & Spouse/Partner Family Parent & Child AETNA DMO (DPO #319) Single Member & Spouse/Partner Family Parent & Child METLIFE (DPO #320) Single Member & Spouse/Partner Family Parent & Child

TOTAL MONTHLY BILLING RATE

$40.98 $80.85 $105.37 $60.94

$25.23 $48.15 $86.43 $76.68

$8.78 $15.27 $24.95 $18.49

$18.39 $31.96 $52.29 $38.72

$22.62 $39.38 $64.42 $47.74

$14.52 $24.61 $39.72 $29.63

HD-1065-0120

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