The PPO plan offers a special waiting period feature where a member’s waiting period if any will be reduced by the number of months the member was covered by the prior plan. Prior proof of coverage is required and effective dates must be within the previous 24 months.

Plan Summary

In-Network

Out-of-Network

Preventive
In-Network
100%
Out-of-Network
100% of Fee Schedule
Basic
In-Network
80%
Out-of-Network
80% of Fee Schedule
Major
In-Network
50%
Out-of-Network
50% of Fee Schedule
Deductible
In-Network
$50 / $150 per person / per family
Out-of-Network
Annual Maximum
of which $500 per year can be used for Major Services.
In-Network
$1000
Out-of-Network
Waiting Period
Basic
In-Network
6 Months
Out-of-Network
Waiting Period
Major
In-Network
12 Months
Out-of-Network
Orthodontics
In-Network
20% Discount (Contracted Provider)
Out-of-Network
No Benefit
Orthodontic Maximum
In-Network
No Maximum
Out-of-Network
N/A
Waiting Period
Orthodontics
In-Network
None
Out-of-Network
N/A

FAQ

Which networks can I use?
When is my plan effective?
Who can I include on my plan?
Does my plan include Vision?
Additional inclusions for Seniors
What if I require specialist services?
Where can I find a copy of my plan brochure?
To which services does my deductible apply?
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