DENTAL CARE

Insurer: Pacific Blue Cross

Policy Number: 20037

Annual deductible

N/A

Dental fee guide

PBC Schedule 3

Specialist fee guide

Fee Guide +10%

Termination Age

The last day of the month in the month in which the employee terminates, retires, or is no longer eligible for coverage.

Survivor extension

For Dental work already in progress, within 90 days following the employees death an eligible dependent of the deceased employee may have dental work completed that commenced as part of a series of planned dental treatment(s) while the employee was living.

Basic Services

Reimbursement

100%

Maximum

$1,500 maximum per calendar year combined with Endodontics/Periodontics and Major Restorative Services

Adult check-up

2 per Calendar year

Child check-up

Once every 6 months

Endodontic/Periodontic Services

Reimbursement

100%

Maximum

$1,500 maximum per calendar year combined with Basic and Major Restorative Services

Major Restorative Services

Reimbursement

60%

Maximum

$1,500 maximum per calendar year combined with Basic and Major Restorative Services

Orthodontic Services

Reimbursement

75%

Maximum

$5,000/Lifetime

Age limit

Covers adults and children

GROUP LIFE

Insurer: Pacific Blue Cross

Policy Number: 79520

Schedule

Flat $25,000

Maximum

$25,000

Termination age

The last day of the month in the month in which the employee terminates, retires, or is no longer eligible for coverage.

Age reduction

N/A

Waiver of premium definition

Matches LTD

Optional life

Available