|What the Plan pays|
|Preventive and diagnostic services1||100%||100%|
|What you pay|
|Annual Deductible (individual/family)2||$50/$100||$75/$150|
|Preventive and diagnostic services||0%||0%|
|Dental Plan Maximums (combined in- and out-of-network)|
|Preventive, diagnostic, basic and major services||$1,500/person per year|
|Orthodontic services||$1,000/person lifetime maximum|
|Temporomandibular joint disease||$1,000/person lifetime maximum|
1 The deductible does not apply to preventive and diagnostic care or to orthodontic services. Coverage for orthodontic services applies to both adults and children.
2 "Family" includes Employee & Spouse/Domestic Partner, Employee & Child(ren), and Employee & Family.