Laserfiche WebLink
Optional-Orthodontic Care Benefits (If Employer Elected) <br /> <br /> Orthodontic Care procedures are limited to eligible <br /> dependent children under age 19, 25 if a full-time <br /> student, with benefits being limited to $400.00 per <br /> child per year with a lifetime maximum of $1,200.00 per <br /> child. The benefits are payable at 50% after a one (1) <br /> year waiting period. <br /> <br />EMPLOYER ELECTED DEDUCTIBLE <br /> <br /> $25.00, $50.00, $100.00 per calendar year with a <br /> three (3) time family deductible limit. <br /> <br />ANNUAL MAXIMUM BENEFIT <br /> <br /> $1,000 per calendar year per insured. <br /> <br />** RATE SUMMARY BASED ON 0% MONTHLY CONTRIBUTION <br /> <br />$25 Deductible <br /> <br />$50 Deductible <br /> <br />Employee Only <br />Employee + Spouse <br />Employee/Children <br /> with orthodontia <br />Full Family/with <br /> orthodontia <br /> <br />$13.44 (14.78) <br />27.68 (30.46) <br /> <br />30.98 (32.54) <br /> <br />45.22 (47.48) <br /> <br />$12.38 (13.62) <br />25.46 (28.02) <br /> <br /> 28.74 (30.18) <br /> 41.84 (43.94) <br /> <br />** RATE SUMMARY BASED ON $3.00 - $8.90 EMPLOYER CONTRIBUTION <br /> <br />Employee Only <br />Employee + Spouse <br />Employee/Children <br /> with orthodontia <br />Full Family/with <br /> orthodontia <br /> <br />$13.06 (14.36) <br />26.92 (29.62) <br /> <br /> 30.14 (31.66) <br /> 43.98 (46.18) <br /> <br />$12.04 (13.24) <br />24.78 (27.26) <br /> <br />27.98 (29.38) <br /> <br />40.72 (42.76) <br /> <br />The numbers that appear in parentheses represent the rates if <br />endodontics and periodontics were increased to an 80% <br />benefit. <br /> <br />The 80% Endodontic and Periodontic benefits are currently <br />awaiting approval from the N.C. State Insurance Department. <br /> <br /> <br />