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 |
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| Eye Examination for Eyeglasses |
Frequency |
Coinsurance |
Deductible |
Max Benefit |
| 1 visit per 12 months |
80% |
$5 per visit |
$25 |
| Choice A: Eye Glasses |
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| 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 |
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| * Single Vision $35, Bifocal $35, Trifocal $50, Lenticular $75 |
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