MACON COUNTY DENTAL

MACON COUNTY DENTAL

Administered by Crescent Health Solutions

BASIC PLAN Plan Year2014 - 2015

Program Deductible Per Individual Family Unit Waived for Type 1 Services

Type I Preventive Services Benefit Waiting Period

Type II Basic Services

Benefit Waiting Period

Type III Major Services

Calendar Year Maximum

Type IV Orthodontia Children

$50 Calendar Year No Limit Yes

100% Oral exams, cleanings (2 per 12 months)

Bitewing x-rays (1 per 12 months) None

80% Space maintainers, fillings, pain treatment, sealants, full mouth x-rays, simple extractions, complex oral surgery, anesthesia None

0% not covered

$1,000

0% not covered

Basic Plan Rates Employee Only Employee + One Employee + Two Employee + Three or more

Per Pay Period $9.18 $18.05 $26.63 $35.49

Please note that a July 1st open enrollment change between the Basic and Enhanced Plans does not reset your currently accumulated deductibles or calendar year maximums for the existing plan year.

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