Plan A (Current Plan) Plan B (New Plan)
PPO Provider Non-PPO Provider in PPO
Area
PPO Provider Non-PPO Provider
Type I (Diagnostic and Preventive
Benefits: exams, cleanings, etc.)
100% 100% of usual and
customary charges
100% 100% of usual and
customary charges
Type II (Restorative and Other
Basic Services: fillings and crowns,
etc.)
80% 80% of usual and
customary charges
None
Type III (Major Restorative
Services: crowns, dentures and
bridges, etc.)
50% 50% of usual and customary charges None
Annual Maximum
None None
Orthodontia Lifetime Maximum of $2,500, available to age 19 None