The Annual Deductible

Restorative care is subject to an annual deductible. The deductible is the amount you must pay "up front" before the Plan begins to pay benefits for covered expenses. After the deductible has been met, you only pay the applicable coinsurance percentage for any subsequent care.

Preventive care is covered in full without a deductible, subject to frequency limitations.

The following table shows the deductibles for restorative care:


Service	Annual Deductible
Preventive care (e.g., cleanings, exams, X-rays, sealants)	No deductible
Restorative services (e.g., fillings, root canals, crowns, bridges, dentures, and orthodontics)	$100 individual $300 family

For restorative care, if you elect coverage for yourself or yourself plus one dependent:

Each covered person must pay all eligible expenses until the individual deductible is met. Then, eligible expenses are covered at the coinsurance indicated for that expense.

After a covered person meets the individual deductible amount, that person will pay no further deductible.

If you elect coverage for yourself plus two or more dependents:

All expenses incurred by you and/or your covered dependents combine to meet the family deductible.

If no one person meets the individual deductible, but combined participant expenses meet the total deductible amount, no further deductible is required.

The maximum deductible any one covered person must pay is equal to the individual amount. After one person meets the individual deductible, that person will pay no further deductible, but other covered persons must continue to pay deductibles until the total is satisfied.


Example: Amounts Applied Toward Restorative Care Deductible
On behalf of you	$100
On behalf of your spouse/domestic partner	$100
On behalf of one child	$40
On behalf of a second child	$60
Total (meets family deductible)	$300
In this example, four people have met the family annual deductible for restorative care. So, any other covered person's restorative care would be reimbursed by the Plan, even if it were on behalf of a person who has not yet met the $100 individual annual deductible. No other covered family members need to meet their restorative care deductible for the rest of the year. Please Note: No more than $100 of expenses per individual will be applied towards the family deductible.