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EDS 100N
Annual Maximum
See schedule of benefits - Schedule can be located online in the AzCA benefits folder
Deductible
Waived for preventive
Preventive
Basic
Major
Orthodontia Deductible
25% discount program
Orthodontia Coinsurance
Orthodontia Maximum
Dental Rewards Program
N/A
Dependent Age
26
RATES
Employee per
Month
Employee per
paycheck
Employee Only
$13.91
$6.42
Employee + One
$24.60
$11.35
Employee + Family
$30.13
$13.99
VOLUNTARY DENTAL PLAN - EDS
AMERITAS Low
AMERITAS High
Annual Maximum
$1,000
$1,500
Deductible
Waived for preventive
$50
$50
Preventive
100%
100%
Basic
80%
80%
Major
50%
50%
Implants
Included
Included
Orthodontia Deductible
N/A
N/A
Orthodontia Coinsurance
50%
50%
Orthodontia Maximum
$1,500
$1,500
Dental Rewards Program
Additional accumulation toward annual maximum
Additional accumulation toward annual maximum
Dependent Age
19; 26 if full-time student
19; 26 if full-time student
RATES
Employee per
Month
Employee per
paycheck
Employee per
Month
Employee per
paycheck
Employee Only
$33.34
$15.39
$37.92
$17.50
Employee + One
$61.59
$28.43
$69.63
$32.14
Employee + Family
$94.11
$47.05
$104.79
$48.36
VOLUNTARY DENTAL PLANS - AMERITAS