Quick facts
Calendar Year Deductible - Individual (In-Network)
$0
Calendar Year Deductible - Family Limit
3 per family
Annual Maximum Benefit (In-Network/Out-of-Network)
$1000
Preventive Care Coinsurance (In-Network/Out-of-Network)
100%
Orthodontia Coverage
Not Covered
Basic Care Coinsurance (In-Network/Out-of-Network)
80%
Major Care Coinsurance (In-Network/Out-of-Network)
50%
Lifetime Orthodontia Maximum
Not Applicable
More details (1)
Dependent Age Limits (Non-Student/Student)
20/26
Carrier contact
(888) 600-1600 — member services
Group number: 00508233
Your member ID card: check the carrier website or app, or ask HR for a copy.
Plan documents
Confirm details with your carrier for current plan information.