Dental

	Option 1: Base		Option 2: Buy-up
	In-Network	Out-of-Network	In-Network	Out-of-Network
Individual	$50	$50	$50	$50
Family Limit	3 per family (applies to all levels)		3 per family (applies to all levels)
Waived For	Preventive	Preventive	Preventive	Preventive
Preventive Care	100%	100%	100%	100%
Basic Care	80%	80%	80%	80%
Major Care	50%	50%	50%	50%
Orthodontia	50%	50%	50%	50%
Annual Max Benefit	$1,500 (applies to all levels)		$2,500 (applies to all levels)
Lifetime Orthodontia Max	$1,000 (applies to all levels)		$2,000 (applies to all levels)

Employee Bi-Weekly Costs: Base Plan
Employee Only	$7.45
Employee + Spouse	$17.31
Employee + Child(ren)	$19.71
Family	$28.46

Employee Bi-Weekly Costs: Buy Up Plan
Employee Only	$9.31
Employee + Spouse	$21.54
Employee + Child(ren)	$26.59
Family	$37.88