Additional Benefits
| Dental Benefits |
|---|
| Annual Maximum Benefits | $750 | | Deductible | $50 | | Coverage A - Exams, Intraoral Films and Bitewings | | Waiting Period | 0 | | Coinsurance | 80% | | Coverage B - Filings, Oral Surgery Repairs for Crowns, Bridges and Dentures | | Waiting Period | 3 months | | Coinsurance | 60% | | Coverage C - Periodontics, Crown, Bridges, Endodontics and Dentures | | Waiting Period | 12 months | | Coinsurance | 50% |
| Short-Term Disability Plan |
|---|
| Maximum Benefit Amount per Week | $150 | | Percentage of Weekly Base Pay | 60% | | Waiting Period (Benefits will begin paying immediately if hospitalized) | 7 days |
| Term Life Plan |
|---|
| Employee Life Benefit (reduces to 75% at age 65, 50% at age 70) | $10,000 | | Spouse (terminates at age 70) | $5,000 | | Dependent (6 months to 24 years) | $5,000 | | Dependent (15 days to 6 months) | $1,000 | | Dependent (under 15 days) | $0 |
| Vision Plan | | | | |
|---|
| Eye Examination for Eyeglasses | Frequency | Coinsurance | Deductible | Max Benefit | | 1 visit per 12 months | 80% | $5 per visit | $25 | | Choice A: Eye Glasses | | | | | | Lenses | 2 lenses per 12 months | 75% | $15 per purchase | $35-$75* | | Frames | 1 pair per 12 months | 75% | $15 per purchase | $25 | | Choice B: Contact Lenses | 2 lenses per 12 months | 75% | $15 per purchase | $95 | | Choice C: Disposable Lenses | 12 month supply per year | 75% | $15 per purchase | $75 | | | | | | | | | | * Single Vision $35, Bifocal $35, Trifocal $50, Lenticular $75 |
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